title: Non-visit-based cancer screening using a novel population management system.
abstract: BACKGROUND
  Advances in information technology (IT) now permit population-based preventive screening, but the best methods remain uncertain. We evaluated whether involving primary care providers (PCPs) in a visit-independent population management IT application led to more effective cancer screening.
  
  
  METHODS
  We conducted a cluster-randomized trial involving 18 primary care practice sites and 169 PCPs from June 15, 2011, to June 14, 2012. Participants included adults eligible for breast, cervical, and/or colorectal cancer screening. In practices randomized to the intervention group, PCPs reviewed real-time rosters of their patients overdue for screening and provided individualized contact (via a letter, practice delegate, or patient navigator) or deferred screening (temporarily or permanently). In practices randomized to the comparison group, overdue patients were automatically sent reminder letters and transferred to practice delegate lists for follow-up. Intervention patients without PCP action within 8 weeks defaulted to the automated control version. The primary outcome was adjusted average cancer screening completion rates over 1-year follow-up, accounting for clustering by physician or practice.
  
  
  RESULTS
  Baseline cancer screening rates (80.8% vs 80.3%) were similar among patients in the intervention (n = 51,071) and comparison group (n = 52,799). Most intervention providers used the IT application (88 of 101, 87%) and users reviewed 7984 patients overdue for at least 1 cancer screening (73% sent reminder letter, 6% referred directly to a practice delegate or patient navigator, and 21% deferred screening). In addition, 6128 letters were automatically sent to patients in the intervention group (total of 12,002 letters vs 16,378 letters in comparison practices; P < .001). Adjusted average cancer screening rates did not differ among intervention and comparison practices for all cancers combined (81.6% vs 81.4%; P = .84) nor breast (82.7% vs 82.7%; P = .96), cervical (84.1% vs 84.7%; P = .60), or colorectal cancer (77.8% vs 76.2%; P = .33).
  
  
  CONCLUSIONS
  Involving PCPs in a visit-independent population management IT application resulted in similar cancer screening rates compared with an automated reminder system, but fewer patients were sent reminder letters. This suggests that PCPs were able to identify and exclude from contact patients who would have received automated reminder letters but not undergone screening.
authors.affiliation: From the General Medicine Division, Medical Services (SJA, JMA, YC, SP-L), the Laboratory of Computer Science (AHZ, HCC), and the Mongan Institute for Health Policy (DEL), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Research, Kaiser Permanente Northern California, Oakland (RWG). satlas@partners.org.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
authors.affiliation: From the General Medicine Division, Medical Services (SJA, JMA, YC, SP-L), the Laboratory of Computer Science (AHZ, HCC), and the Mongan Institute for Health Policy (DEL), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Research, Kaiser Permanente Northern California, Oakland (RWG).
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Zai
authors.affiliation: From the General Medicine Division, Medical Services (SJA, JMA, YC, SP-L), the Laboratory of Computer Science (AHZ, HCC), and the Mongan Institute for Health Policy (DEL), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Research, Kaiser Permanente Northern California, Oakland (RWG).
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ashburner
authors.affiliation: From the General Medicine Division, Medical Services (SJA, JMA, YC, SP-L), the Laboratory of Computer Science (AHZ, HCC), and the Mongan Institute for Health Policy (DEL), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Research, Kaiser Permanente Northern California, Oakland (RWG).
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: From the General Medicine Division, Medical Services (SJA, JMA, YC, SP-L), the Laboratory of Computer Science (AHZ, HCC), and the Mongan Institute for Health Policy (DEL), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Research, Kaiser Permanente Northern California, Oakland (RWG).
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
authors.affiliation: From the General Medicine Division, Medical Services (SJA, JMA, YC, SP-L), the Laboratory of Computer Science (AHZ, HCC), and the Mongan Institute for Health Policy (DEL), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Research, Kaiser Permanente Northern California, Oakland (RWG).
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Levy
authors.affiliation: From the General Medicine Division, Medical Services (SJA, JMA, YC, SP-L), the Laboratory of Computer Science (AHZ, HCC), and the Mongan Institute for Health Policy (DEL), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Research, Kaiser Permanente Northern California, Oakland (RWG).
authors.forename: Henry C
authors.initials: HC
authors.lastname: Chueh
authors.affiliation: From the General Medicine Division, Medical Services (SJA, JMA, YC, SP-L), the Laboratory of Computer Science (AHZ, HCC), and the Mongan Institute for Health Policy (DEL), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Research, Kaiser Permanente Northern California, Oakland (RWG).
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D011216:Practice Management, Medical; D011320:Primary Health Care; D017010:Reminder Systems / Q000706:statistics & numerical data*
keywords: Cancer Screening; Prevention; Primary Health Care