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1 Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, NH
2 Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH
3 Clinical Directors Network, New York, NY
4 Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
5 Affinity Health Plan, Bronx, NY
6 Department of Sociology, Dartmouth College, Lebanon, NH
7 Department of Anesthesiology, Dartmouth Medical School, Lebanon, NH
CORRESPONDING AUTHOR: Allen J. Dietrich, MD, Department of Community and Family Medicine, 7927 Rubin, Room 834, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, Allen.J.Dietrich{at}dartmouth.edu
PURPOSE An earlier randomized controlled trial of prevention care management (PCM) found significant improvement in breast, cervical, and colorectal cancer-screening rates among women attending Community Health Centers but required substantial research support. This study evaluated the impact of a streamlined PCM delivered through a Medicaid managed care organization (MMCO), an infrastructure with the potential to sustain this program for the long term.
METHODS This randomized trial was conducted within an MMCO serving New York City between May 2005 and December 2005. A total of 1,316 women aged 40 to 69 years and not up to date for at least 1 targeted cancer-screening test were randomized to either PCM or a comparison group. Women in the PCM group received up to 3 scripted telephone calls to identify barriers and provide support to obtain any needed breast, cervical, and colorectal cancer-screening tests. Women in the comparison group received a modified version of the MMCO’s established mammography telephone outreach program, also in up to 3 calls. Women in both groups received a financial incentive on confirmation that they had received a mammogram. Screening status was assessed through MMCO administrative data. Groups were compared using odds ratios.
RESULTS In an intent-to-treat comparison adjusted for baseline screening status, PCM women were 1.69 times more likely to be up-to-date for colorectal cancer-screening tests at follow-up than women in the comparison group (95% confidence interval, 1.03–2.77). Follow-up screening rates for cervical and breast cancer did not differ significantly between study groups on an intent-to-treat basis.
CONCLUSIONS The abbreviated PCM telephone intervention was feasible to deliver through an MMCO and improved screening for 1 cancer. This approach has the potential to improve cancer-screening rates significantly in settings that can provide telephone support to women known to be overdue.
Key Words: Breast neoplasms/ethnology/prevention & control • colorectal neoplasms/ethnology/prevention & control • uterine cervical neoplasms/ethnology/prevention & control • telephone • managed care programs • poverty • New York City • intervention studies • Medicaid
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