PROMOTING SCREENING MAMMOGRAPHY IN INNER-CITY SETTINGS - A RANDOMIZEDCONTROLLED TRIAL OF COMPUTERIZED REMINDERS AS A COMPONENT OF A PROGRAM TO FACILITATE MAMMOGRAPHY

In a one-year randomized controlled trial, we assessed the effectivene ss of a computerized mammography reminder system as a component of a p rogram to increase the use of screening mammography in three health ca re organizations serving inner-city women in Detroit, Michigan (two si tes of a health department, one HMO site, and two sites of a private h ospital). Four thousand four hundred and one women older than 40 who h ad visited a study site in the preceding year were randomly assigned t o one of two treatment groups. Limited intervention (LI) included phys ician and staff breast cancer control education, facilitated mammograp hy appointment scheduling procedures, and elimination of out-of-pocket patient cost for mammography (at three of five sites). Full intervent ion (FI) included all components of limited intervention plus an addit ional series of ''cues-to-action.'' These included a mammography remin der form inserted in the medical record of women who were due to have mammography, intended to increase physician referral for mammography a ppointments, and patient reminders intended to increase completion of mammography among referred women. During the one-year intervention per iod 2,725 randomized women visited a study site. The 6-month mammograp hy appointment rates among Fl women vary from 38% to 65% and the FI ra te exceeds the LI rate at each site with differences from 13% (95% Cl, 6 to 20) to 29% (21 to 38). The annual completed mammography rate amo ng FI women extends from 43% to 64% and exceeds the LI rate at each si te by 12% (5 to 19) to 25% (16 to 34). After age-adjustment, the mammo graphy intervention effect sizes among the five sites were not signifi cantly different. The average increase in FI compared to LI was 18%. T he computerized reminder system is effective in increasing the use of mammography in each of the study institutions and the major effect is on physician referral for mammography.