title: Mailings timed to patients' appointments: a controlled trial of fecal occult blood test cards.
abstract: BACKGROUND
  Fecal occult blood testing (FOBT) programs cost-effectively reduce colon cancer mortality. To improve the rate of colon cancer screening with FOBT, we tested the effect of mailing FOBT cards timed to appointments on the rates of completion of FOBT.
  
  
  METHODS
  Controlled trial.
  
  
  METHODS
  A total of 119 patients with primary care appointments scheduled in May or June 2000 for an urban, public hospital clinic that serves predominantly low-income, African Americans with chronic diseases. The patients in the study were selected by linking a quality improvement registry, the appointment system database, and an FOBT database to generate a list of clinic patients who had not completed an FOBT in the preceding year.
  
  
  METHODS
  Subjects were assigned to either a system of mailing FOBT cards and reminders 2 weeks prior to a scheduled appointment or usual care.
  
  
  METHODS
  The primary outcomes were the rate of screening at the index appointment and during the year beginning with the date of the index appointment.
  
  
  RESULTS
  The rate of return of the FOBT cards during the year beginning with the index appointment was 40.7% for the intervention group compared to 5% for the usual care group (odds ratio [OR]=13.0, p <0.001). The difference was accounted for largely by increases in screening at the index appointment (35.6% compared to 3.3%, OR=16.0, p <0.001).
  
  
  CONCLUSIONS
  Using computer databases to generate a list of patients due for FOBT and then mailing FOBT cards timed to a scheduled appointment significantly increased the rate of colon cancer screening. This may be an efficient approach to increasing colon cancer screening with FOBT.
authors.affiliation: Division of General Medicine, John H. Stroger Jr. Hospital of Cook County, Rush University, Chicago, Illinois 60612, USA. David_Goldberg@rush.edu
authors.forename: David
authors.initials: D
authors.lastname: Goldberg
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
authors.forename: Robert
authors.initials: R
authors.lastname: McNutt
authors.forename: Alice
authors.initials: A
authors.lastname: Furumoto-Dawson
authors.forename: Martha
authors.initials: M
authors.lastname: Hammerman
authors.forename: Arthur
authors.initials: A
authors.lastname: Hoffman
mesh_terms: D001071:Appointments and Schedules; D002641:Chicago; D003110:Colonic Neoplasms / Q000517:prevention & control*; D019992:Databases as Topic; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D009780:Occult Blood; D017063:Outcome Assessment, Health Care; D017010:Reminder Systems