Translation of an efficacious cancer-screening intervention to women enrolled in a Medicaid managed care organization

Abstract

Purpose: An earlier randomized controlled trial of prevention care management (PCM) found significant improvement in breast, cervical, and colorectal cancer-screening rates among women attending Community Health Centers but required substantial research support. This study evaluated the impact of a streamlined PCM delivered through a Medicaid managed care organization (MMCO), an infrastructure with the potential to sustain this program for the long term.

Methods: This randomized trial was conducted within an MMCO serving New York City between May 2005 and December 2005. A total of 1,316 women aged 40 to 69 years and not up to date for at least 1 targeted cancer-screening test were randomized to either PCM or a comparison group. Women in the PCM group received up to 3 scripted telephone calls to identify barriers and provide support to obtain any needed breast, cervical, and colorectal cancer-screening tests. Women in the comparison group received a modified version of the MMCO's established mammography telephone outreach program, also in up to 3 calls. Women in both groups received a financial incentive on confirmation that they had received a mammogram. Screening status was assessed through MMCO administrative data. Groups were compared using odds ratios.

Results: In an intent-to-treat comparison adjusted for baseline screening status, PCM women were 1.69 times more likely to be up-to-date for colorectal cancer-screening tests at follow-up than women in the comparison group (95% confidence interval, 1.03-2.77). Follow-up screening rates for cervical and breast cancer did not differ significantly between study groups on an intent-to-treat basis.

Conclusions: The abbreviated PCM telephone intervention was feasible to deliver through an MMCO and improved screening for 1 cancer. This approach has the potential to improve cancer-screening rates significantly in settings that can provide telephone support to women known to be overdue.

Trial registration: ClinicalTrials.gov NCT00376909.

Figure 1.

Relationship of the randomized trial study groups to the established program.

Figure 2.

Flow of participants through randomization and treatment. * Dropouts include women who, by the time of their initial call, (1) were no longer insured by Affinity, (2) were no longer receiving care at a participating Community Health Center, or (3) declined telephone support.