Reminders Boost Mammogram Rates

A reminder program aimed at screening for breast cancer when it is most treatable boosted mammography rates by more than 17 percentage points, according to a new study by Kaiser Permanente's Center for Health Research in the August issue of the American Journal of Preventive Medicine. The program used electronic health records to identify women who would soon be due for a mammogram and reached out to them via postcards, automated voice messages and personal phone calls. 
The study of 35,000 Kaiser Permanente members is the largest to test a reminder program involving this three-pronged approach.  By the second year of the program in 2008, mammography rates jumped from 63 to more than 80 percent among women aged 50-69.
"We know mammograms are effective, but  too many women put them off, even when they have health insurance," said study lead author Adrianne Feldstein, MD, MS, an investigator at Kaiser Permanente's Center for Health Research in Portland, Ore., and a practicing physician. "This study is the first to show that these reminder programs can be effective in such a large group of women.  If we could improve the country's mammography rate by the same amount, we could detect as many as 25,000 additional cases of breast cancer each year."
"Our study shows that a reminder program can spark a big improvement in a short amount of time," said study co-author Nancy Perrin, Ph.D., senior investigator at Kaiser Permanente's Center for Health Research in Portland, Ore. "The reminder program was so successful that we have now implemented it for all women in our health plan who are eligible for mammograms," added Perrin."
Breast cancer is the most common cancer among women in the United States, with one in eight developing breast cancer and 46,000 dying from it annually. Although regular mammograms can reduce breast cancer deaths by more than 30 percent and the U.S. Preventive Services Task Force recommends screenings every 1-2 years for women over age 40, current screening rates fall short of these guidelines.
The study is part of Kaiser Permanente's ongoing effort to encourage preventive health through diligent cancer screenings. Nationwide, Kaiser Permanente has an array of services designed to ensure screening for breast cancer, ranging from mobile screening vans, breast health fairs, to built-in prompts in its electronic health records system, KP HealthConnect™ — the world's largest civilian electronic health record.
Funded by the National Cancer Institute, this study involved employees using Kaiser Permanente's robust electronic health records database to identify women (aged 50-69) who hadn't had a mammogram for 20 months. Starting in January 2006, these women were sent a postcard telling them that they soon would be due for another mammogram.  If they didn't make an appointment within a month, they received their first automated reminder call.  A month later, they received a second automated call, and one month after that, if they still had not made an appointment, they received a call from a clerk in the radiology department.   Within 10 months of their first reminder, more than 75 percent of these women had completed their mammograms—compared to only 63.4 percent before the program started.  After the second year of the reminder program, 80.6 percent of women had completed their mammograms. 
While previous trials have examined the effectiveness of mammogram reminder programs, few have addressed implementation and maintenance of these programs. This trial is noteworthy because of its size—most previous trials involved fewer than 1,000 women—and because it incorporated automated calls; most of the previous research had focused only on mail and live telephone counseling reminders.
The study was not a randomized controlled trial, and women in the comparison groups were not the same age as those in the target group.  However, screening rates in the comparison groups did not improve, which leads the authors to believe that improvements in the target group were indeed a result of the reminder program.
Study authors include: Adrianne Feldstein, MD, MS; Nancy Perrin, Ph.D.; A. Gabriela Rosales, MS; Jennifer Schneider, MPH; and Mary M. Rix, RN, all with the Kaiser Permanente Center for Health Research in Portland, Ore.; Stephanie Schoap, MBA, and Kara Keels of Kaiser Permanente Northwest in Portland, Ore.; and Russell E. Glasgow, Ph.D., of the Institute for Health Research, Kaiser Permanente, Penrose, Colo.