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Research ArticleOriginal Research

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

Lindsay Phillips, Samantha Hendren, Sharon Humiston, Paul Winters and Kevin Fiscella
The Journal of the American Board of Family Medicine January 2015, 28 (1) 46-54; DOI: https://doi.org/10.3122/jabfm.2015.01.140174
Lindsay Phillips
From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
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Samantha Hendren
From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
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Sharon Humiston
From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
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Paul Winters
From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
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Kevin Fiscella
From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
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    Table 1. Baseline Characteristics of Patients Past Due for Mammography Screening By Intervention Group
    CharacteristicsInterventionP Value
    Group 1 (Letter) (n = 90)Group 2 (Automated Phone Call) (n = 88)Group 3 (Letter and Automated Phone Call) (n = 93)
    Age (years).5095
        50–5957.8 (52)59.1 (52)65.6 (61)
        ≥6042.2 (38)40.9 (36)34.4 (32)
    Race/ethnicity.9718
        Non-Hispanic white77.9 (67)79.8 (67)76.3 (71)
        Non-Hispanic black11.6 (10)9.5 (8)12.9 (12)
        Other (eg, Hispanic)10.5 (9)10.7 (9)10.8 (10)
    Household income.8252
        ≥$40,00048.9 (44)52.3 (46)52.7 (49)
        $30,000-$39,99926.7 (24)28.4 (25)22.6 (21)
        <$30,00024.4 (22)19.3 (17)24.7 (23)
    Insurance*.0034
        Private48.9 (44)51.1 (45)69.9 (65)
        Medicare38.9 (35)26.1 (23)19.4 (18)
        Medicaid12.2 (11)22.7 (20)10.7 (10)
    Preintervention screening rates*0 (0)0 (0)0 (0)NA
    • Data are % (n). Small discrepancies between the total number of patients in a group and the summed numbers in the columns reflect data missing for that variable.

    • ↵* By design, patients without insurance or who were up to date on breast cancer and colorectal cancer screening were excluded from the study.

    • NA, not applicable.

    • View popup
    Table 2. Baseline Characteristics of Patients Past Due for Colorectal Cancer Screening By Intervention Group
    CharacteristicsInterventionP Value
    Group 1 (Letter) (n = 198)Group 2 (Automated Phone Call) (n = 199)Group 3 (Letter and Automated Phone Call) (n = 203)
    Sex.7824
        Female62.63 (124)63.3 (126)60.1 (122)
        Male37.4 (74)36.7 (73)39.9 (81)
    Age (years).2677
        50–5964.1 (127)68.3 (136)60.6 (123)
        ≥6035.9 (71)31.7 (63)39.4 (80)
    Race/ethnicity.7464
        Non-Hispanic black14.6 (28)13.0 (25)12.4 (25)
        Other (eg, Hispanic)7.3 (14)10.4 (20)7.5 (15)
        Non-Hispanic white78.1 (150)76.6 (147)80.1 (161)
    Household income.3797
        ≥$40,00053.5 (106)58.1 (115)55.0 (111)
        $30,000-$39,00028.8 (57)21.7 (43)22.3 (45)
        <$30,00017.7 (35)20.2 (40)22.8 (46)
    Insurance.4658
        Private61.1 (121)62.8 (125)68.5 (139)
        Medicaid12.1 (24)14.1 (28)9.8 (20)
        Medicare26.8 (53)23.1 (46)21.7 (44)
    Preintervention screening rates0 (0)0 (0)0 (0)NA
    • Data are % (n). Small discrepancies between the total number of patients in a group and the summed numbers in the columns reflect data missing for that variable.

    • * By design, patients without insurance or who were up to date on breast cancer and colorectal cancer screening were excluded from the study.

    • NA, not applicable.

    • View popup
    Table 3. Unadjusted and Adjusted Postintervention Breast and Colorectal Cancer Screening Rates*
    UnadjustedAdjusted†
    Screened (%)P Value‡Screened (Adjusted %)P Value‡
    Breast cancer screen
        Letter18.9.006220.3.0300
        Automated call21.6.020924.3.0053
        Letter and automated call36.639.1
    Colorectal cancer screen
        Letter16.7.051920.0.0297
        Automated call13.6.006016.5.0022
        Letter and automated call24.128.5
    • ↵* By definition, preintervention screening rates for each randomization group were 0% for both mammography and colorectal cancer screening.

    • ↵† Screening rate adjusted for age, race/ethnicity, income, and insurance.

    • ↵‡ P values are for the single vs combined intervention.

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The Journal of the American Board of Family     Medicine: 28 (1)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 1
January-February 2015
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Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both
Lindsay Phillips, Samantha Hendren, Sharon Humiston, Paul Winters, Kevin Fiscella
The Journal of the American Board of Family Medicine Jan 2015, 28 (1) 46-54; DOI: 10.3122/jabfm.2015.01.140174

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Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both
Lindsay Phillips, Samantha Hendren, Sharon Humiston, Paul Winters, Kevin Fiscella
The Journal of the American Board of Family Medicine Jan 2015, 28 (1) 46-54; DOI: 10.3122/jabfm.2015.01.140174
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