Patient Navigation to Increase Mammography Screening Among Inner City Women

Phillips, C. E.; Rothstein, Jessica D.; Beaver, Kristine; Sherman, Bonnie J.; Freund, Karen M.; Battaglia, Tracy A.

doi:10.1007/s11606-010-1527-2

Cited by 120 publications

(121 citation statements)

References 23 publications

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“…Numerous strategies exist to improve screening rates for colorectal and breast cancer, 2,3,5,6,[11][12][13][14][15][16][17][18][19][20] but the relative incremental benefit of these interventions have not been compared. 5 Using a pragmatic randomized trial, we examined the incremental benefit of several strategies to augment the effect of a patient reminder letter to improve cancer-screening rates.…”

Section: Discussionmentioning

confidence: 99%

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

et al. 2013

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BACKGROUND:Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments. OBJECTIVE: To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice. DESIGN: Pragmatic randomized trial. PARTICIPANTS: Men and women aged 50-74 years past due for CRC screen and women aged 40-74 years past due for BC screening. INTERVENTIONS: We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call). MAIN MEASURES: Documentation of mammography or colorectal cancer screening at 52 weeks following randomization. KEY RESULTS: Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2-4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1-3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1-3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0-3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates. CONCLUSIONS:The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.KEY WORDS: cancer screening; colorectal cancer; breast cancer; outreach; inreach.

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Section: Discussionmentioning

confidence: 99%

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

et al. 2013

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“…5,6 Furthermore, patient navigation programs and other forms of tailored patient counseling that remove access barriers such as cost, transportation and appointment-scheduling have been proven successful. [7][8][9][10] Unfortunately, expensive or complex strategies such as patient navigator programs may not be feasible in the underClinical Trial Registry: The trial was registered at Clinical Trials.gov (NCT00818857) resourced primary care practices in which many poor and minority patients receive care. [10][11][12] By contrast, electronic physician reminders have little effect on screening rates, and solitary, lower-cost interventions (mailed patient reminders, automated phone calls) increase screening rates, but only modestly.…”

Section: Introductionmentioning

confidence: 99%

Randomized, Controlled Trial of a Multimodal Intervention to Improve Cancer Screening Rates in a Safety-Net Primary Care Practice

et al. 2013

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BACKGROUND: Cancer screening rates are suboptimal for low-income patients. OBJECTIVE: To assess an intervention to increase cancer screening among patients in a safety-net primary care practice. DESIGN: Patients at an inner-city family practice who were overdue for cancer screening were randomized to intervention or usual care. Screening rates at 1 year were compared using the chi-square test, and multivariable analysis was performed to adjust for patient factors. SUBJECTS: All average-risk patients at an inner-city family practice overdue for mammography or colorectal cancer (CRC) screening. Patients' ages were 40 to 74 years (mean 53.9, SD 8.7) including 40.8 % African Americans, 4.2 % Latinos, 23.2 % with Medicaid and 10.9 % without any form of insurance. INTERVENTION: The 6-month intervention to promote cancer screening included letters, automated phone calls, prompts and a mailed Fecal Immunochemical Testing (FIT) Kit. MAIN MEASURES: Rates of cancer screening at 1 year. KEY RESULTS: Three hundred sixty-six patients overdue for screening were randomly assigned to intervention (n=185) or usual care (n=181). Primary analysis revealed significantly higher rates of cancer screening in intervention subjects: 29.7 % vs. 16.7 % for mammography (p =0.034) and 37.7 % vs. 16.7 % for CRC screening (p=0.0002). In the intervention group, 20 % of mammography screenings and 9.3 % of CRC screenings occurred at the early assessment, while the remainder occurred after repeated interventions. Within the CRC intervention group 44 % of screened patients used the mailed FIT kit. On multivariable analysis the CRC screening rates remained significantly higher in the intervention group, while the breast cancer screening rates were not statistically different. CONCLUSIONS: A multimodal intervention significantly increased CRC screening rates among patients in a safety-net primary care practice. These results suggest that relatively inexpensive letters and automated calls can be combined for a larger effect. Results also suggest that mailed screening kits may be a promising way to increase average-risk CRC screening.KEY WORDS: breast neoplasms; colorectal neoplasms; cancer screening; healthcare disparities.

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“…Both programs are funded through the Avon Foundation, which has Published online December 15, 2010 provided consistent support for breast cancer care to safety net programs over the past decade. The study by Phillips and colleagues 16 addressed low HEDIS-measured screening mammography, and studied the impact of patient navigation through a pre-post difference in difference analysis. The 10% improvement in HEDIS rates achieved by the intervention is noteworthy in that it would allow such a safety net system to benefit from most pay for performance programs.…”

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confidence: 99%

Patient Navigation: The Promise to Reduce Health Disparities

Freund

2010

J GEN INTERN MED

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Patient Navigation to Increase Mammography Screening Among Inner City Women

Abstract: Patient navigation improves biennial mammography rates for inner city, low income, minority populations.

Cited by 120 publications

References 23 publications

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

Randomized, Controlled Trial of a Multimodal Intervention to Improve Cancer Screening Rates in a Safety-Net Primary Care Practice

Patient Navigation: The Promise to Reduce Health Disparities

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