title: Telephone outreach to increase colon cancer screening in medicaid managed care organizations: a randomized controlled trial.
abstract: OBJECTIVE
  Health Plans are uniquely positioned to deliver outreach to members. We explored whether telephone outreach, delivered by Medicaid managed care organization (MMCO) staff, could increase colorectal cancer (CRC) screening among publicly insured urban women, potentially reducing disparities.
  
  
  METHODS
  We conducted an 18-month randomized clinical trial in 3 MMCOs in New York City in 2008-2010, randomizing 2,240 MMCO-insured women, aged 50 to 63 years, who received care at a participating practice and were overdue for CRC screening. MMCO outreach staff provided cancer screening telephone support, educating patients and helping overcome barriers. The primary outcome was the number of women screened for CRC during the 18-month intervention, assessed using claims.
  
  
  RESULTS
  MMCO staff reached 60% of women in the intervention arm by telephone. Although significantly more women in the intervention (36.7%) than in the usual care (30.6%) arm received CRC screening (odds ratio [OR] = 1.32; 95% CI, 1.08-1.62), increases varied from 1.1% to 13.7% across the participating MMCOs, and the overall increase was driven by increases at 1 MMCO. In an as-treated comparison, 41.8% of women in the intervention arm who were reached by telephone received CRC screening compared with 26.8% of women in the usual care arm who were not contacted during the study (OR = 1.84; 95% CI, 1.38, 2.44); 7 women needed to be reached by telephone for 1 to become screened.
  
  
  CONCLUSIONS
  The telephone outreach intervention delivered by MMCO staff increased CRC screening by 6% more than usual care among randomized women, and by 15.1% more than usual care among previously overdue women reached by the intervention. Our research-based intervention was successfully translated to the health plan arena, with variable effects in the participating MMCOs.
authors.affiliation: Community and Family Medicine, Norris Cotton Cancer Center, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA. allen.j.dietrich@dartmouth.edu
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Dietrich
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Tobin
authors.forename: Christina M
authors.initials: CM
authors.lastname: Robinson
authors.forename: Andrea
authors.initials: A
authors.lastname: Cassells
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Greene
authors.forename: Van H
authors.initials: VH
authors.lastname: Dunn
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Falkenstern
authors.forename: Rosanna
authors.initials: R
authors.lastname: De Leon
authors.forename: Michael L
authors.initials: ML
authors.lastname: Beach
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D016001:Confidence Intervals; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008484:Medicaid / Q000458:organization & administration*; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D016387:Women's Health
keywords: Medicaid; cancer screening; claims data