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A Cluster-Randomized Trial of a Primary Care Informatics-Based System for Breast Cancer Screening

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Abstract

BACKGROUND

Information technology offers the promise, as yet unfulfilled, of delivering efficient, evidence-based health care.

OBJECTIVE

To evaluate whether a primary care network-based informatics intervention can improve breast cancer screening rates.

DESIGN

Cluster-randomized controlled trial of 12 primary care practices conducted from March 20, 2007 to March 19, 2008.

PATIENTS

Women 42–69 years old with no record of a mammogram in the prior 2 years.

INTERVENTIONS

In intervention practices, a population-based informatics system was implemented that: connected overdue patients to appropriate care providers, presented providers with a Web-based list of their overdue patients in a non-visit-based setting, and enabled “one-click” mammography ordering or documented deferral reasons. Patients selected for mammography received automatically generated letters and follow-up phone calls. All practices had electronic health record reminders about breast cancer screening available during clinical encounters.

MAIN MEASURES

The primary outcome was the proportion of overdue women undergoing mammography at 1-year follow-up.

KEY RESULTS

Baseline mammography rates in intervention and control practices did not differ (79.5% vs 79.3%, p = 0.73). Among 3,054 women in intervention practices and 3,676 women in control practices overdue for mammograms, intervention patients were somewhat younger, more likely to be non-Hispanic white, and have health insurance. Most intervention providers used the system (65 of 70 providers, 92.9%). Action was taken for 2,652 (86.8%) intervention patients [2,274 (74.5%) contacted and 378 (12.4%) deferred]. After 1 year, mammography rates were significantly higher in the intervention arm (31.4% vs 23.3% in control arm, p < 0.001 after adjustment for baseline differences; 8.1% absolute difference, 95% CI 5.1–11.2%). All demographic subgroups benefited from the intervention. Intervention patients completed screening sooner than control patients (p < 0.001).

CONCLUSIONS

A novel population-based informatics system functioning as part of a non-visit-based care model increased mammography screening rates in intervention practices.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT00462891

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Funding Sponsor

This study was supported by a grant from the National Cancer Institute (NCI 1 R21 CA121908) and by institutional funding through the Massachusetts General Hospital Primary Care Operations Improvement program. Dr. Grant is supported by an NIDDK Career Development Award (K23 DK067452). No funding source had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Prior Presentations

Presented at the Society of General Internal Medicine Annual Meeting, Pittsburgh, PA, April 10, 2008 and the 2008 AHRQ PBRN Research Conference, Bethesda, MD, June 11, 2008.

Conflict of Interest

None disclosed.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Steven J. Atlas MD, MPH.

Electronic Supplementary Materials

Below is the link to the electronic supplementary material.

Provider use of the population management Web page: A demonstration of how physicians and population managers accessed the informatics tool, reviewed their list of overdue patients, and used clinically relevant decision support information to initiate or defer the mammography screening process. File Format: .mov (MOV 9599 kb)

Practice delegate use of the population management Web page: A demonstration of how practice delegates accessed the informatics tool, reviewed their list of patients to contact, and directly used the radiology scheduling system for patients who wished to schedule a mammogram or documented deferral reasons for patients who did not. File Format: .mov (MOV 10152 kb)

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Atlas, S.J., Grant, R.W., Lester, W.T. et al. A Cluster-Randomized Trial of a Primary Care Informatics-Based System for Breast Cancer Screening. J GEN INTERN MED 26, 154–161 (2011). https://doi.org/10.1007/s11606-010-1500-0

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  • DOI: https://doi.org/10.1007/s11606-010-1500-0

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