Journal of General Internal Medicine

, Volume 26, Issue 2, pp 154–161

A Cluster-Randomized Trial of a Primary Care Informatics-Based System for Breast Cancer Screening

  • Steven J. Atlas
  • Richard W. Grant
  • William T. Lester
  • Jeffrey M. Ashburner
  • Yuchiao Chang
  • Michael J. Barry
  • Henry C. Chueh
Original Research

DOI: 10.1007/s11606-010-1500-0

Cite this article as:
Atlas, S.J., Grant, R.W., Lester, W.T. et al. J GEN INTERN MED (2011) 26: 154. doi:10.1007/s11606-010-1500-0

Abstract

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

KEY WORDS

primary carescreeningmammographyhealth information technologyrandomized controlled trial

Supplementary material

View video
Online Video 1

Provider use of the population management Web page: A demonstration of how physicians and population managers accessed the informatics tool, reviewed their list of overdue patients, and used clinically relevant decision support information to initiate or defer the mammography screening process. File Format: .mov (MOV 9599 kb)

View video
Online Video 2

Practice delegate use of the population management Web page: A demonstration of how practice delegates accessed the informatics tool, reviewed their list of patients to contact, and directly used the radiology scheduling system for patients who wished to schedule a mammogram or documented deferral reasons for patients who did not. File Format: .mov (MOV 10152 kb)

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Steven J. Atlas
    • 3
  • Richard W. Grant
    • 3
  • William T. Lester
    • 2
  • Jeffrey M. Ashburner
    • 1
  • Yuchiao Chang
    • 3
  • Michael J. Barry
    • 3
  • Henry C. Chueh
    • 2
  1. 1.General Medicine DivisionMassachusetts General HospitalBostonUSA
  2. 2.Laboratory of Computer ScienceMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.General Medicine DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonUSA