Web-Based Proactive System to Improve Breast Cancer Screening

Abstract

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 identifiedashavingconsentedtoparticipateinresearch,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 (PϽ.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, PϽ.001; e-mail vs US mail; P=.24). Conclusion:The breast cancer screening rate improved significantly with the practice redesign of having appointment secretariesproactivelymanagebreastcancerscreeningneeds.

The Effect of an Automated Clinical Reminder on Weight Loss in Primary Care

“…Breast cancer screening rates were significantly better when using an automated clinical prompt. 9 Similar improvement in screening for abdominal aortic aneurysms was noted using programmed reminders. 10 Clinical reminders positively affected osteoporosis screening rates.…”

“…The GDMS extracts information from the electronic medical record to improve patient care with rulesbased reminders for preventative services, diabetes, and coronary artery disease care. 9 The application is frequently revised to include updated recommendations. In the ECH practice, a summary of GDMS recommendations is printed at each patient visit to enable the clinician to discuss recommendations with the patient.…”

Non-Visit-Based Cancer Screening Using a Novel Population Management System

“…However, similar screening rates were achieved with significantly fewer reminder letters in intervention practices where PCPs reviewed their overdue patients, and intervention PCPs reported spending less time during clinic hours on cancer screening tasks. Studies have shown that involvement of a PCP [23][24][25][26][27][28] and non-visit-based reminder systems 10,[12][13][14][15][16][17]36,37 can increase rates of preventive cancer screening. The current study demonstrates that an automated reminder IT application without physician input led to similar screening rates for patients who seemed to be overdue for up to 3 widely recommended cancers: breast, cervical, and colorectal.…”

“…10,11 Non-visit-based reminder systems for cancer screening, including those using health information technology (IT), have been shown to increase screening rates but generally focus on only a single condition. [12][13][14][15][16][17] We showed improved screening rates using a population management system in which primary care providers (PCPs) reviewed a list of their patients overdue for breast cancer screening and, if needed, took action to initiate a cascade of downstream events. 18,19 This model of care emphasizes management outside of office visits and provides a framework to facilitate the efficient allocation of limited clinical resources.…”

Clinical informatics to improve quality of care: a population-based system for patients with diabetes mellitus

“…23,24 We previously reported that our redesigned care process, which involved work with allied health staff, standardisation of care, and use of an electronic, webbased tool, significantly improved breast cancer screening for female patients in our practice without requiring additional physician or nurse time. 25 Appointment secretaries were trained to use the clinical informatics system PRECARES (PREventive CAre REminder System) to proactively contact patients before they were due for mammography and to schedule it at their convenience. PRECARES was next further developed to include tests that patients with diabetes need every 12 months (HbA1c, LDL, and urine microalbumin), as recommended by most national guidelines, 26 and also USPSTF-recommended adult preventive services.…”