Journal of General Internal Medicine

, Volume 29, Issue 1, pp 90–97 | Cite as

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

  • Robert J. Fortuna
  • Amna Idris
  • Paul Winters
  • Sharon G. Humiston
  • Steven Scofield
  • Samantha Hendren
  • Patricia Ford
  • Shirley X. L. Li
  • Kevin Fiscella
Original Research



Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments.


To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice.


Pragmatic randomized trial.


Men and women aged 50–74 years past due for CRC screen and women aged 40–74 years past due for BC screening.


We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call).


Documentation of mammography or colorectal cancer screening at 52 weeks following randomization.


Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2–4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1–3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1–3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0–3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates.


The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.


cancer screening colorectal cancer breast cancer outreach inreach 




All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline.

Grant Support

This project was supported by the American Cancer Society - RSGT-08-077-01-CPHPS.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2013_2586_MOESM1_ESM.pdf (131 kb)
ESM 1 (PDF 131 kb)


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Robert J. Fortuna
    • 1
  • Amna Idris
    • 2
  • Paul Winters
    • 2
  • Sharon G. Humiston
    • 3
  • Steven Scofield
    • 1
  • Samantha Hendren
    • 4
  • Patricia Ford
    • 2
  • Shirley X. L. Li
    • 2
  • Kevin Fiscella
    • 2
    • 5
  1. 1.Center for Primary Care and Department of Internal Medicine, Culver Medical GroupUniversity of Rochester School of Medicine and DentistryRochesterUSA
  2. 2.Department of Family Medicine and Community & Preventive MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA
  3. 3.Department of PediatricsChildren’s Mercy Hospitals and ClinicsKansas CityUSA
  4. 4.Department of SurgeryUniversity of MichiganAnn ArborUSA
  5. 5.Family Medicine Research ProgramsUniversity of RochesterRochesterUSA

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