Population-based breast cancer screening in a primary care network.

Atlas SJ1, Ashburner JM, Chang Y, Lester WT, Barry MJ, Grant RW.

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Abstract

OBJECTIVES:

To assess the ability of a health information technology system to facilitate population- based breast cancer screening.

STUDY DESIGN:

Cohort study with 2-year follow-up after a 1-year cluster randomized trial.

METHODS:

Study population was women 42 to 69 years old receiving care within a 12-practice primary care network. The management informatics system (1) identified women overdue for mammograms, (2) connected them to primary care providers using a web-based tool, (3) created automatically generated outreach letters for patients specified by providers, (4) monitored for subsequent mammography scheduling and completion, and (5) provided practice delegates with a list of women remaining unscreened for reminder phone calls. Eligible women overdue for a mammogram during a 1-year study period included those overdue at study start (prevalent cohort) and those who became overdue during follow-up (incident cohort). The main outcome measure was mammography completion rates over 3 years.

RESULTS:

Among 32,688 eligible women, 9795 (30%) were overdue for screening (4487 intervention, 5308 control). Intervention patients were somewhat younger, more likely to be non-Hispanic white, and more likely to have health insurance compared with control patients. Adjusted completion rates in the prevalent cohort (n = 6697) were significantly higher among intervention patients after 3 years (51.7% vs 45.8%; P = .002). For patients in the incident cohort (n = 3098), adjusted completion rates after 2 years were 53.8% versus 48.7%, respectively (P = .052).

CONCLUSIONS:

Population-based informatics systems can enable sustained increases in mammography screening rates beyond rates seen with office-based visit reminders.