A Multimodal Intervention to Promote Mammography and Colorectal Cancer Screening in a Safety-Net Practice

作者：Fiscella Kevin^*; Humiston Sharon; Hendren Samantha; Winters Paul; Idris Amna; Li Shirley X L; Ford Patricia; Specht Raymond; Marcus Steven

来源：Journal of the National Medical Association, 2011, 103(8): 762-768.

DOI：10.1016/s0027-9684(15)30417-x

• colorectal
• cancer
• urban population

Background: There are limited data regarding interventions designed to improve cancer screening rates in safety-net practices with "real world" patients.
Objective: To examine the impact of a multimodal intervention on mammography and colorectal cancer (CRC) screening rates in a safety-net practice caring for under-served patients.
Methods: At an inner-city family medicine practice, all patients past due for mammography or CRC screening were assigned to receive or not receive a screening promotion intervention based on their medical record number. The 12-month intervention included outreach to patients (tailored letters, automated and personal phone calls) and point-of-care patient and clinician prompts. The trial was registered at clinicaltrials.gov, NCT00818857.
Results: We enrolled 469 participants aged 40 to 74 years, including 28% African Americans, 5% Latinos, 25% with Medicaid, and 10% without any form of insurance. Participants in the intervention group showed statistically significantly higher rates of cancer screening; rates were 41% vs 16.8% for mammography and 28.8% vs 10% for CRC screening. These findings were confirmed in multivariable analysis. Similar relative improvements in screening were seen across race, ethnicity, socioeconomic status, and insurance groups.
Discussion: A multimodal intervention shows promise for improving rates of mammography and colorectal cancer screening within a safety-net practice. Further study will identify the most cost-effective components of the intervention.

• 出版日期2011-8