Web-based proactive system to improve breast cancer screening: a randomized controlled trial.
BACKGROUND
Screening mammography is recommended for early detection of breast cancer but screening rates remain suboptimal.


METHODS
A primary care portal for a large academic primary practice was developed for all preventive services. Another Web-based system (PRECARES [PREventive CAre REminder System]) was developed for appointment secretaries to manage proactive breast cancer screening. Female patients aged 40 to 75 years were randomly assigned to a control group (usual care) and an intervention group. For the intervention group, 2 monthly letters inviting patients to undergo mammography were sent starting 3 months before they were due for annual screening, followed by a telephone call to nonresponding patients. A subgroup of women employees was further randomized to receive a reminder by either US mail or e-mail.


RESULTS
Of the total eligible population of 6665 women identified as having consented to participate in research, 3339 were randomly assigned to the control group and 3326 to the intervention group. The screening rate for annual mammography was 64.3% for the intervention group and 55.3% for the control group (P <.001). There were no significant differences between the 2 groups for any of the other adult preventive services. For the employee subgroup, the screening rate was 57.5% for the control group, 68.1% for the US mail group, and 72.2% for the e-mail group (intervention vs control, P <.001; e-mail vs US mail; P = .24).


CONCLUSIONS
The breast cancer screening rate improved significantly with the practice redesign of having appointment secretaries proactively manage breast cancer screening needs.
Chaudhry
Rajeev
R
Divisions of Primary Care Internal Medicine, and the Quality Office, Mayo Clinic, Rochester, MN 55905, USA. chaudhry.rajeev@mayo.edu
Scheitel
Sidna M
SM
McMurtry
Erin K
EK
Leutink
Dorinda J
DJ
Cabanela
Rosa L
RL
Naessens
James M
JM
Rahman
Ahmed S
AS
Davis
Lynn A
LA
Stroebel
Robert J
RJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D001071:Appointments and Schedules; D001943:Breast Neoplasms / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D008910:Minnesota; D009816:Office Automation; D011216:Practice Management, Medical; D011320:Primary Health Care; D017010:Reminder Systems; D012111:Residence Characteristics