Document Detail


A cluster-randomized trial of a primary care informatics-based system for breast cancer screening.
MedLine Citation:
PMID:  20872083     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Steven J Atlas; Richard W Grant; William T Lester; Jeffrey M Ashburner; Yuchiao Chang; Michael J Barry; Henry C Chueh
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-09-15
Journal Detail:
Title:  Journal of general internal medicine     Volume:  26     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-12     Completed Date:  2011-11-10     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  154-61     Citation Subset:  IM    
Affiliation:
General Medicine Division, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Boston, MA 02114, USA. satlas@partners.org
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00462891
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Breast Neoplasms / diagnosis*,  epidemiology
Cluster Analysis
Early Detection of Cancer / methods*,  trends
Female
Follow-Up Studies
Humans
Mammography / trends
Medical Informatics / methods*,  trends
Middle Aged
Primary Health Care / methods*
Grant Support
ID/Acronym/Agency:
1 R21 CA121908/CA/NCI NIH HHS; K23 DK067452/DK/NIDDK NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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