EHR-assisted mammo program increases screening rate

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A program aimed at screening for breast cancer when it is most treatable boosted mammography rates by more than 17 percentage points, according to research by Kaiser Permanente's Center for Health Research in the August issue of the American Journal of Preventive Medicine. The program used an EHR to identify women who would be due for a mammogram and contacted them via postcards, automated voice messages and personal phone calls.

The study of the reminder program involving this three-pronged approach involved 35,000 Kaiser members. 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 the lead author Adrianne Feldstein, MD, 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."

"Automated reminder programs make it more convenient for people to focus on staying healthy by getting the screenings they need," said study co-author Nancy Perrin, PhD, senior investigator at Kaiser Permanente's Center for Health Research.

Funded by the National Cancer Institute (NCI), the study involved employees using Kaiser's EHR database to identify women (aged 50-69) who had not had a mammogram for 20 months.

Starting in January 2006, the women were sent a postcard telling them that they soon would be due for another mammogram, according to the authors. If they did not 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.

The researchers found that within 10 months of their first reminder, more than 75 percent of these women had completed their mammograms--compared with only 63.4 percent who did so before the program started. After the second year of the reminder program, 80.6 percent of women had completed their mammograms.

The authors noted that 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.