Simon Steven R, Zhang Fang, Soumerai Stephen B, Ensroth Arthur, Bernstein Lydia, Fletcher Robert H, Ross-Degnan Dennis
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
Arch Intern Med. 2010 Feb 8;170(3):264-70. doi: 10.1001/archinternmed.2009.522.
Automated telephone outreach with speech recognition (ATO-SR) is used extensively by health plans. Whether ATO-SR can increase rates of colorectal cancer (CRC) screening is unknown.
We randomly allocated 40 000 health plan members to ATO-SR and 40 000 to usual care, of whom 10 432 and 10 506 in the intervention and usual care groups, respectively, had not been previously screened and were therefore eligible for analysis. The intervention was a single interactive outreach call using speech recognition to engage participants in conversation about the importance of CRC screening and options for and barriers to screening. The intervention directed participants to contact their primary care provider to schedule screening. The primary end point was any CRC screening in the year following intervention. Colonoscopy in the year following intervention was a secondary outcome.
The incidence of any CRC screening was 30.6% in the intervention group and 30.4% in the usual care group (P = .76). After adjustment for available covariates, there remained no intervention effect (adjusted odds ratio [OR], 1.01; 95% confidence interval [CI], 0.94-1.07). A total of 21.4% of members in the intervention group and 20.3% in the usual care group underwent colonoscopy (P = .04). In multivariate analysis, there was a small intervention effect on colonoscopy (OR, 1.08; 95% CI, 1.00-1.16).
This study showed that ATO-SR failed to improve rates of CRC screening. Future studies should examine approaches that combine efforts to target patients and their health care providers to overcome the barriers to CRC screening. Trial Registration clinicaltrials.gov Identifier: NCT00792285.
健康计划广泛使用带有语音识别功能的自动电话外展服务（ATO-SR）。ATO-SR能否提高结直肠癌（CRC）筛查率尚不清楚。
我们将40000名健康计划成员随机分为ATO-SR组和常规护理组，每组各40000人，其中干预组和常规护理组分别有10432人和10506人此前未接受过筛查，因此符合分析条件。干预措施是通过一次使用语音识别的交互式外展电话，让参与者参与关于CRC筛查的重要性、筛查选项及障碍的对话。该干预指导参与者联系其初级保健提供者安排筛查。主要终点是干预后一年内的任何CRC筛查。干预后一年内的结肠镜检查是次要结局。
干预组的任何CRC筛查发生率为30.6%，常规护理组为30.4%（P = 0.76）。在对可用协变量进行调整后，仍无干预效果（调整后的优势比[OR]为1.01；95%置信区间[CI]为0.94 - 1.07）。干预组共有21.4%的成员接受了结肠镜检查，常规护理组为20.3%（P = 0.04）。在多变量分析中，干预对结肠镜检查有较小的效果（OR为1.08；95% CI为1.00 - 1.16）。
本研究表明ATO-SR未能提高CRC筛查率。未来的研究应探讨结合针对患者及其医疗保健提供者的努力以克服CRC筛查障碍的方法。试验注册 clinicaltrials.gov标识符：NCT00792285。
