Chaudhry Rajeev, Scheitel Sidna M, McMurtry Erin K, Leutink Dorinda J, Cabanela Rosa L, Naessens James M, Rahman Ahmed S, Davis Lynn A, Stroebel Robert J
Divisions of Primary Care Internal Medicine, and the Quality Office, Mayo Clinic, Rochester, MN 55905, USA.
Arch Intern Med. 2007 Mar 26;167(6):606-11. doi: 10.1001/archinte.167.6.606.
Screening mammography is recommended for early detection of breast cancer but screening rates remain suboptimal.
A primary care portal for a large academic primary practice was developed for all preventive services. Another Web-based system (PRECARES [PREventive CAre REminder System]) was developed for appointment secretaries to manage proactive breast cancer screening. Female patients aged 40 to 75 years were randomly assigned to a control group (usual care) and an intervention group. For the intervention group, 2 monthly letters inviting patients to undergo mammography were sent starting 3 months before they were due for annual screening, followed by a telephone call to nonresponding patients. A subgroup of women employees was further randomized to receive a reminder by either US mail or e-mail.
Of the total eligible population of 6665 women identified as having consented to participate in research, 3339 were randomly assigned to the control group and 3326 to the intervention group. The screening rate for annual mammography was 64.3% for the intervention group and 55.3% for the control group (P <.001). There were no significant differences between the 2 groups for any of the other adult preventive services. For the employee subgroup, the screening rate was 57.5% for the control group, 68.1% for the US mail group, and 72.2% for the e-mail group (intervention vs control, P <.001; e-mail vs US mail; P = .24).
The breast cancer screening rate improved significantly with the practice redesign of having appointment secretaries proactively manage breast cancer screening needs.
推荐进行乳腺钼靶筛查以早期发现乳腺癌，但筛查率仍未达到最佳水平。
为所有预防服务开发了一个大型学术初级医疗机构的初级保健门户网站。还开发了另一个基于网络的系统（PRECARES[预防保健提醒系统]），供预约秘书管理主动乳腺癌筛查。40至75岁的女性患者被随机分为对照组（常规护理）和干预组。对于干预组，在她们应进行年度筛查前3个月开始每月发送两封信，邀请患者进行乳腺钼靶检查，随后对未回复的患者进行电话随访。女性员工亚组进一步随机分为通过美国邮政或电子邮件接收提醒。
在确定同意参与研究的6665名女性合格总人口中，3339名被随机分配到对照组，3326名被随机分配到干预组。干预组年度乳腺钼靶筛查率为64.3%，对照组为55.3%（P<.001）。两组在任何其他成人预防服务方面均无显著差异。对于员工亚组，对照组筛查率为57.5%，美国邮政组为68.1%，电子邮件组为72.2%（干预组与对照组相比，P<.001；电子邮件组与美国邮政组相比，P = 0.24）。
通过重新设计让预约秘书主动管理乳腺癌筛查需求的做法，乳腺癌筛查率显著提高。
