Article Figures & Data
Figures
- Figure 1.
Relationship of the randomized trial study groups to the established program.
- Figure 2.
Flow of participants through randomization and treatment.
* Dropouts include women who, by the time of their initial call, (1) were no longer insured by Affinity, (2) were no longer receiving care at a participating Community Health Center, or (3) declined telephone support.
Tables
Characteristic PCM Mean (SD) or No. (%) (n=663) AMOP Mean (SD) or No. (%) (n=653) PCM = prevention care management; AMOP = Affinity Mammography Outreach Program (the comparison group). * Women had to have been enrolled with Affinity for at least 1 year to be eligible for this study. † Primary language was derived from administrative records; no primary language was noted for 271 PCM women and 263 AMOP women. Age, y Mean 50.3 (7.14) 50.0 (6.90) 40–49 346 (52.2) 344 (52.7) 50–59 242 (36.5) 240 (36.8) ≥60 75 (11.3) 69 (10.6) Time since initial enrollment with Affinity, y* 1–3 388 (58.5) 372 (57.0) 3–5 48 (7.2) 58 (8.9) >5 227 (34.2) 222 (34.0) Primary language† English 336 (85.7) 316 (81.0) Spanish 52 (13.3) 71 (18.2) Other 4 (1.0) 3 (0.8) - Table 2.
Comparison of Up-to-Date Status Between Study Groups, at Baseline and at Follow-up, According to Intent-to-Treat Analysis Among All Women
Unadjusted Comparison Adjusted Comparison* Screening PCM No. (%) Up-to-Date AMOP No. (%) Up-to-Date OR (95% CI) P Value OR (95% CI) P Value PCM = prevention care management; AMOP = Affinity Mammography Outreach Program (the comparison group); OR = odds ratio; CI = confidence interval. * Baseline breast and cervical comparisons are adjusted for age (40 to 49 years, 50 years and older); there is no adjusted colorectal baseline comparison because this analysis included only women aged 50 years and older. Follow-up comparisons are adjusted for age (breast and cervical) and for baseline screening status (all 3 screenings). † Smaller n values for colorectal screening reflect the subset of the study population who were eligible for colorectal cancer screening (ie, aged 50 years and older). ‡P≤.05. Breast (n=663) (n=653) Baseline 219 (33) 217 (33) 0.99 (0.78–1.26) .94 0.97 (0.75–1.27) .85 Follow-up 343 (52) 326 (50) 1.08 (0.86–1.34) .51 1.16 (0.86–1.57) .33 Cervical (n=663) (n=653) Baseline 344 (52) 333 (51) 1.04 (0.83–1.29) .75 1.03 (0.83–1.29) .76 Follow-up 423 (64) 403 (62) 1.09 (0.87–1.38) .43 1.18 (0.82–1.70) .38 Colorectal† (n=317) (n=309) Baseline 56 (18) 48 (16) 1.17 (0.75–1.82) .47 – – Follow-up 103 (32) 78 (25) 1.43 (0.99–2.05) .05 1.69‡ (1.03–2.77) .04 - Table 3.
Comparison of Up-to-Date Status Between Study Groups, at Baseline and at Follow-up, According to Subgroup Analysis Among Women Reached by Telephone at Least Once, Still Eligible, and Willing to Participate
Unadjusted Comparison Adjusted Comparison* Screening PCM No. (%) Up-to-Date AMOP No. (%) Up-to-Date OR (95% CI) P Value OR (95% CI) P Value PCM = prevention care management; AMOP = Affinity Mammography Outreach Program (the comparison group); OR = odds ratio; CI = confidence interval. * Baseline breast and cervical comparisons are adjusted for age (40 to 49 years, 50 years and older); there is no adjusted colorectal baseline comparison because this analysis included only women aged 50 years and older. Follow-up comparisons are adjusted for age (breast and cervical) and for baseline screening status (all 3 screenings). †P ≤.05. ‡ Smaller n values for colorectal screening reflect the subset of the study population who were eligible for colorectal cancer screening (ie, aged 50 years and older). Breast (n=268) (n=271) Baseline 111 (41.4) 133 (49.1) 0.73 (0.51–1.05) .07 0.69 (0.46–1.04) .08 Follow-up 192 (71.6) 193 (71.2) 1.02 (0.69–1.51) .91 1.39 (0.88–2.20) .16 Cervical (n=268) (n=271) Baseline 155 (57.8) 160 (59.0) 0.95 (0.67–1.36) .78 0.95 (0.68–1.35) .79 Follow-up 207 (77.2) 195 (72.0) 1.32 (0.88–1.99) .16 1.86† (1.08–3.21) .03 Colorectal‡ (n=152) (n=160) Baseline 25 (16.4) 27 (16.9) 0.97 (0.51–1.84) .92 – – Follow-up 52 (34.2) 44 (27.5) 1.37 (0.82–2.29) .20 1.84 (0.95–3.58) .07
Supplemental Tables
Supplemental Table 1. Comparisons of Up-to-Date Status at Follow-up, Excluding Women Who Were Up-to-Date on a Given Screening at Baseline Supplemental Table 2. Comparisons of Up-to-Date Status at Follow-up Among Women Who Were Reached by Telephone at Least Once, Still Eligible, and Willing to Participate, Excluding Women Who Were Up-to-Date on a Given Screening at Baseline
Files in this Data Supplement:
- Supplemental data: Table 1 - PDF file, 1 page, 101 KB
- Supplemental data: Table 2 - PDF file, 1 page, 89 KB
The Article in Brief
Allen J. Dietrich, MD, and colleagues
Background In an earlier study, called Prevention Care Management (PCM), women who received health care from federally funded Community Health Centers and were not up-to-date for breast, cervical, or colorectal cancer screening, received reminder telephone calls and other assistance from trained telephone staff. The current study explores whether a streamlined version of PCM is effective when offered through a Medicaid managed care organization.
What This Study Found The modified Prevention Care Management program can be implemented and modestly improves cancer screening rates. Women in the modified PCM program were 1.69 times more likely to be up-to-date for colorectal cancer screening tests than women in a comparison group. Screening rates for cervical and breast cancer did not differ significantly between the groups.
Implications
- Like the original Prevention Care Management program, the streamlined study increases cancer screening. This finding suggests that a telephone care management program for cancer screening can be translated to a real-world setting.
- This approach has the potential to improve cancer-screening rates in settings that can provide telephone support to women known to be overdue for cancer screening.
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