title: Personalized targeted mailing increases mammography among long-term noncompliant medicare beneficiaries: a randomized trial.
abstract: OBJECTIVE
  The study purpose was to increase mammography screening among older women by identifying female Medicare beneficiaries without a recent mammogram and assesses the cost-effectiveness of a personalized targeted mailing encouraging them to have a mammogram.
  
  
  METHODS
  A randomized paired controlled trial included 1229 pairs of women matched on zip code, race, and urban or rural county. Postintervention mammography claims were measured from November 1997 through December 1998. The subjects were female Medicare beneficiaries age > or = 70, living in Michigan for > or = 5 years, having no significant comorbidity likely to affect screening, and no mammogram for > or = 5 years. Intervention subjects received a personally addressed letter from the Medical Director of Michigan Medicare with materials emphasizing the individual's lack of use of the Medicare mammography screening benefit, reasons for screening, and how to be screened.
  
  
  RESULTS
  Women who received the mailing were 60% more likely to have a subsequent mammogram (OR 1.6, P <0.005), with diagnostic mammograms increasing more than screening mammograms (2.8% vs. 0.8%). The absolute increase was greatest for women age 70 to 79, 10.6% in the intervention group versus 6.5% for controls, odds ratio 1.7 (P <0.02). A statewide Medicare intervention in Michigan would cost of 108,000 US dollars to 238,000 US dollars, producing 3500 to 4300 additional mammograms at 31 US dollars to 55 US dollars per additional mammogram.
  
  
  CONCLUSIONS
  The intervention increased mammography among long-term noncompliant older women, particularly increasing diagnostic mammograms. This approach can be directly implemented in other states and nationally. It may also be useful for other preventive services.
authors.affiliation: Department of Medical Education, University of Michigan, Ann Arbor 48109, USA. rvh@umich.edu
authors.forename: R Van
authors.initials: RV
authors.lastname: Harrison
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Tedeschi
authors.forename: Michael
authors.initials: M
authors.lastname: Chernew
authors.forename: Jeoffrey K
authors.initials: JK
authors.lastname: Stross
authors.forename: Xuelin
authors.initials: X
authors.lastname: Huang
authors.forename: Laurence F
authors.initials: LF
authors.lastname: McMahon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D006278:Medicare; D008824:Michigan; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017010:Reminder Systems; D040241:Social Marketing; D016312:Treatment Refusal; D014481:United States