title: A multimodal intervention to promote mammography and colorectal cancer screening in a safety-net practice.
abstract: BACKGROUND
  There are limited data regarding interventions designed to improve cancer screening rates in safety-net practices with "real world" patients.
  
  
  OBJECTIVE
  To examine the impact of a multimodal intervention on mammography and colorectal cancer (CRC) screening rates in a safety-net practice caring for underserved patients.
  
  
  METHODS
  At an inner-city family medicine practice, all patients past due for mammography or CRC screening were assigned to receive or not receive a screening promotion intervention based on their medical record number. The 12-month intervention included outreach to patients (tailored letters, automated and personal phone calls) and point-of-care patient and clinician prompts. The trial was registered at clinicaltrials.gov, NCT00818857.
  
  
  RESULTS
  We enrolled 469 participants aged 40 to 74 years, including 28% African Americans, 5% Latinos, 25% with Medicaid, and 10% without any form of insurance. Participants in the intervention group showed statistically significantly higher rates of cancer screening; rates were 41% vs 16.8% for mammography and 28.8% vs 10% for CRC screening. These findings were confirmed in multivariable analysis. Similar relative improvements in screening were seen across race, ethnicity, socioeconomic status, and insurance groups.
  
  
  CONCLUSIONS
  A multimodal intervention shows promise for improving rates of mammography and colorectal cancer screening within a safety-net practice. Further study will identify the most cost-effective components of the intervention.
authors: Department of Family Medicine, University of Rochester School of Medicine and Dentistry, New York, USA. kevin_fiscella@urmc.rochester.edu
authors: Kevin
authors: K
authors: Fiscella
authors: Sharon
authors: S
authors: Humiston
authors: Samantha
authors: S
authors: Hendren
authors: Paul
authors: P
authors: Winters
authors: Amna
authors: A
authors: Idris
authors: Shirley X L
authors: SX
authors: Li
authors: Patricia
authors: P
authors: Ford
authors: Raymond
authors: R
authors: Specht
authors: Steven
authors: S
authors: Marcus
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control; D003113:Colonoscopy / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*; D014505:Urban Population