title: Population-based breast cancer screening in a primary care network.
abstract: To assess the ability of a health information technology system to facilitate population- based breast cancer screening.
  
  
  
  Cohort study with 2-year follow-up after a 1-year cluster randomized trial.
  
  
  
  Study population was women 42 to 69 years old receiving care within a 12-practice primary care network. The management informatics system (1) identified women overdue for mammograms, (2) connected them to primary care providers using a web-based tool, (3) created automatically generated outreach letters for patients specified by providers, (4) monitored for subsequent mammography scheduling and completion, and (5) provided practice delegates with a list of women remaining unscreened for reminder phone calls. Eligible women overdue for a mammogram during a 1-year study period included those overdue at study start (prevalent cohort) and those who became overdue during follow-up (incident cohort). The main outcome measure was mammography completion rates over 3 years.
  
  
  
  Among 32,688 eligible women, 9795 (30%) were overdue for screening (4487 intervention, 5308 control). Intervention patients were somewhat younger, more likely to be non-Hispanic white, and more likely to have health insurance compared with control patients. Adjusted completion rates in the prevalent cohort (n = 6697) were significantly higher among intervention patients after 3 years (51.7% vs 45.8%; P = .002). For patients in the incident cohort (n = 3098), adjusted completion rates after 2 years were 53.8% versus 48.7%, respectively (P = .052).
  
  
  
  Population-based informatics systems can enable sustained increases in mammography screening rates beyond rates seen with office-based visit reminders.
authors.affiliation: General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. satlas@partners.org
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ashburner
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: William T
authors.initials: WT
authors.lastname: Lester
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barry
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007256:Information Systems / Q000706:statistics & numerical data*; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D017010:Reminder Systems