title: Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening.
abstract: BACKGROUND
  Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments.
  
  
  OBJECTIVE
  To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice.
  
  
  METHODS
  Pragmatic randomized trial.
  
  
  METHODS
  Men and women aged 50-74 years past due for CRC screen and women aged 40-74 years past due for BC screening.
  
  
  METHODS
  We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call).
  
  
  METHODS
  Documentation of mammography or colorectal cancer screening at 52 weeks following randomization.
  
  
  RESULTS
  Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2-4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1-3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1-3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0-3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates.
  
  
  CONCLUSIONS
  The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.
authors.affiliation: Center for Primary Care and Department of Internal Medicine, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY, 14609, USA, Robert_Fortuna@URMC.Rochester.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fortuna
authors.forename: Amna
authors.initials: A
authors.lastname: Idris
authors.forename: Paul
authors.initials: P
authors.lastname: Winters
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.forename: Steven
authors.initials: S
authors.lastname: Scofield
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
authors.forename: Patricia
authors.initials: P
authors.lastname: Ford
authors.forename: Shirley X L
authors.initials: SX
authors.lastname: Li
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis; D015709:Correspondence as Topic; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D009518:New York; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017010:Reminder Systems; D012959:Socioeconomic Factors; D013689:Telephone