Web-based proactive system to improve breast cancer screening: a randomized controlled trial.

BACKGROUND Screening mammography is recommended for early detection of breast cancer but screening rates remain suboptimal. METHODS A primary care portal for a large academic primary practice was developed for all preventive services. Another Web-based system (PRECARES [PREventive CAre REminder System]) was developed for appointment secretaries to manage proactive breast cancer screening. Female patients aged 40 to 75 years were randomly assigned to a control group (usual care) and an intervention group. For the intervention group, 2 monthly letters inviting patients to undergo mammography were sent starting 3 months before they were due for annual screening, followed by a telephone call to nonresponding patients. A subgroup of women employees was further randomized to receive a reminder by either US mail or e-mail. RESULTS Of the total eligible population of 6665 women identified as having consented to participate in research, 3339 were randomly assigned to the control group and 3326 to the intervention group. The screening rate for annual mammography was 64.3% for the intervention group and 55.3% for the control group (P <.001). There were no significant differences between the 2 groups for any of the other adult preventive services. For the employee subgroup, the screening rate was 57.5% for the control group, 68.1% for the US mail group, and 72.2% for the e-mail group (intervention vs control, P <.001; e-mail vs US mail; P = .24). CONCLUSION The breast cancer screening rate improved significantly with the practice redesign of having appointment secretaries proactively manage breast cancer screening needs.

[1]  Dorothy Y. Hung,et al.  Influence of primary care practice and provider attributes on preventive service delivery. , 2006, American journal of preventive medicine.

[2]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[3]  Beth A Virnig,et al.  Measuring Breast, Colorectal, and Prostate Cancer Screening With Medicare Claims Data , 2002, Medical care.

[4]  Katrina M. Krause,et al.  Primary care: is there enough time for prevention? , 2003, American journal of public health.

[5]  Hoangmai H Pham,et al.  Delivery of preventive services to older adults by primary care physicians. , 2005, JAMA.

[6]  William DuMouchel,et al.  A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. , 1996, Journal of the American Medical Informatics Association : JAMIA.

[7]  Robert H. Miller,et al.  Efforts to Improve Patient Safety in Large, Capitated Medical Groups: Description and Conceptual Model , 2002, Journal of health politics, policy and law.

[8]  C. McDonald,et al.  A computerized reminder system to increase the use of preventive care for hospitalized patients. , 2001, The New England journal of medicine.

[9]  James C. Robinson,et al.  How different is California? A comparison of U.S. physician organizations. , 2003, Health affairs.

[10]  S Kamen,et al.  The task force. , 1976, Journal of hospital dental practice.

[11]  J. Guralnik,et al.  Preventive services for breast and cervical cancer in U.S. office-based practices. , 1996, Preventive medicine.

[12]  J. Goodwin,et al.  Using Medicare data to estimate the prevalence of breast cancer screening in older women: comparison of different methods to identify screening mammograms. , 2002, Health services research.

[13]  Bruce Landon,et al.  Paying for quality: providers' incentives for quality improvement. , 2004, Health affairs.

[14]  S. Shapiro,et al.  Periodic screening for breast cancer: the HIP Randomized Controlled Trial. Health Insurance Plan. , 1997, Journal of the National Cancer Institute. Monographs.

[15]  B. B. Fleming,et al.  Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels. , 2000, JAMA.

[16]  Leif I. Solberg,et al.  Making “Time” for Preventive Services , 1993 .

[17]  U. P. S. T. Force.  Guide to Clinical Preventive Services: Report of the U S Preventive Services Task Force , 1996 .

[18]  D. Blumenthal,et al.  Physicians’ Assessments of Their Ability to Provide High-Quality Care in a Changing Health Care System , 2001, Medical care.

[19]  E. McGlynn,et al.  Profiling the quality of care in twelve communities: results from the CQI study. , 2004, Health affairs.

[20]  R. Luckmann,et al.  Characteristics of Primary Care Office Systems as Predictors of Mammography Utilization , 1993, Annals of Internal Medicine.

[21]  E. McGlynn,et al.  The quality of health care delivered to adults in the United States. , 2003, The New England journal of medicine.

[22]  Ingvar Andersson,et al.  Long-term effects of mammography screening: updated overview of the Swedish randomised trials , 2002, The Lancet.

[23]  Allen Tw.  Guide to clinical preventive services. Report of the US Preventive Services Task Force. , 1991 .

[24]  L. Solberg,et al.  STEP(ing)-UP to deliver clinical preventive services. , 2001, American journal of preventive medicine.

[25]  L. Casalino,et al.  Benefits of and barriers to large medical group practice in the United States. , 2003, Archives of internal medicine.