title: Mailed outreach and facilitated test ordering to promote cholesterol screening in community health centers: A randomized trial.
abstract: OBJECTIVE
  Lipid screening is central to cardiovascular risk assessment. We sought to determine whether a simple mailed outreach message and facilitated test ordering increase cholesterol screening among federally qualified community health center patients with no recent cholesterol screening test performed.
  
  
  METHODS
  Using a patient-randomized controlled trial, we examined the effects of delivering a simple mailed outreach intervention promoting cholesterol testing and facilitated test ordering (without requiring an office visit). Participants were adult patients 50 to 75 years old, with no diagnosed cardiovascular disease or diabetes, and no cholesterol test within 5 years who had received care from community health centers in Illinois and Arizona. The intervention took place in 2014 and was powered to detect a 10% increase in screening due to the intervention.
  
  
  RESULTS
  Participants' (n = 480) mean age was 57.5 years, 51.0% were male, and 43.8% were smokers. There was no significant difference between groups in the primary study outcome-completion of total cholesterol and high-density lipoprotein cholesterol tests or complete lipid panel within 3 months; 32 participants (13.3%) in intervention group versus 26 (10.8%) in control group met the primary outcome, with absolute difference of 2.5 percentage points (95% confidence interval -6.6 to 11.6).
  
  
  CONCLUSIONS
  This outreach intervention promoting cholesterol screening was ineffective. Interventions that attempt to minimize barriers to cholesterol screening on multiple fronts and that are more compelling to patients are needed.
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.|Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Persell
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Brown
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: North Country Healthcare, Flagstaff, AZ, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Henley
authors.affiliation: Near North Health Service Corporation, Chicago, IL, USA.|Alliance of Chicago Community Health Services, Chicago, IL, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Long
authors.affiliation: Near North Health Service Corporation, Chicago, IL, USA.|Heartland Health Outreach, Chicago, IL, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sanchez
authors.affiliation: North Country Healthcare, Flagstaff, AZ, USA.
authors.forename: Regina
authors.initials: R
authors.lastname: Knight
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood*; D003151:Community Health Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D011177:Postal Service; D012307:Risk Factors
chemical_list: D008055:Lipids; D002784:Cholesterol
keywords: cardiovascular disease prevention; cholesterol; federally qualified health centers; primary care; screening