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Randomized Controlled Trial
. 2014 Jan;29(1):90-7.
doi: 10.1007/s11606-013-2586-y.

Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening

Robert J Fortuna  1 , Amna Idris, Paul Winters, Sharon G Humiston, Steven Scofield, Samantha Hendren, Patricia Ford, Shirley X L Li, Kevin Fiscella
Affiliations
Randomized Controlled Trial

Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening

Robert J Fortuna et al. J Gen Intern Med. 2014 Jan.

Abstract

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.

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Figure 1.
Patient randomization flow chart.
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