A cluster-randomized trial of a primary care informatics-based system for breast cancer screening

Journal Name: 
J Gen Intern Med
BACKGROUND: Information technology offers the promise, as yet unfulfilled, of delivering efficient, evidence-based health care. OBJECTIVE: To evaluate whether a primary care network-based informatics intervention can improve breast cancer screening rates. DESIGN: Cluster-randomized controlled trial of 12 primary care practices conducted from March 20, 2007 to March 19, 2008. PATIENTS: Women 42-69 years old with no record of a mammogram in the prior 2 years. INTERVENTIONS: In intervention practices, a population-based informatics system was implemented that: connected overdue patients to appropriate care providers, presented providers with a Web-based list of their overdue patients in a non-visit-based setting, and enabled "one-click" mammography ordering or documented deferral reasons. Patients selected for mammography received automatically generated letters and follow-up phone calls. All practices had electronic health record reminders about breast cancer screening available during clinical encounters. MAIN MEASURES: The primary outcome was the proportion of overdue women undergoing mammography at 1-year follow-up. KEY RESULTS: Baseline mammography rates in intervention and control practices did not differ (79.5% vs 79.3%, p = 0.73). Among 3,054 women in intervention practices and 3,676 women in control practices overdue for mammograms, intervention patients were somewhat younger, more likely to be non-Hispanic white, and have health insurance. Most intervention providers used the system (65 of 70 providers, 92.9%). Action was taken for 2,652 (86.8%) intervention patients [2,274 (74.5%) contacted and 378 (12.4%) deferred]. After 1 year, mammography rates were significantly higher in the intervention arm (31.4% vs 23.3% in control arm, p < 0.001 after adjustment for baseline differences; 8.1% absolute difference, 95% CI 5.1-11.2%). All demographic subgroups benefited from the intervention. Intervention patients completed screening sooner than control patients (p < 0.001). CONCLUSIONS: A novel population-based informatics system functioning as part of a non-visit-based care model increased mammography screening rates in intervention practices. TRIAL REGISTRATION: ClinicalTrials.gov; NCT00462891
20, 50, 70, Adult, Aged, Boston, Breast, Breast Neoplasms, clinical, Cluster Analysis, Comparative Study, Diagnosis, differences, Early Detection of Cancer, electronic, epidemiology, Female, Follow-Up Studies, Health, health care, hospital, Humans, Informatics, information, Insurance, intervention, Letters, Mammography, Massachusetts, medical, Medical Informatics, Medicine, Methods, Middle Aged, Multicenter Studies, patient, Patients, primary care, Primary Health Care, provider, Record, Research, Research Support, support, system, trends, women