Telephone Outreach to Increase Colon Cancer Screening in Medicaid Managed Care Organizations: A Randomized Controlled Trial
Telephone Outreach to Increase Colon Cancer Screening in Medicaid Managed Care Organizations: A Randomized Controlled Trial
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DOI：
10.1370/afm.1469
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发表时间：
2013-07-01
影响因子：
4.4
通讯作者：
Beach, Michael L.
中科院分区：
文献类型：
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作者：
Dietrich, Allen J.;Tobin, Jonathan N.;Beach, Michael L.
目的健康计划具有独特的优势，可以向会员提供外展服务。我们探讨了由 Medicaid 管理式医疗组织 (MMCO) 工作人员提供的电话外展是否可以增加公共参保城市女性的结直肠癌 (CRC) 筛查，从而有可能减少差异。 方法 2008 年至 2010 年，我们在纽约市的 3 个 MMCO 中进行了一项为期 18 个月的随机临床试验，随机抽取了 2,240 名年龄在 50 至 63 岁之间的 MMCO 参保女性，她们在参与诊所接受护理，并且CRC 筛查逾期。 MMCO 外展人员提供癌症筛查电话支持、教育患者并帮助克服障碍。主要结果是在 18 个月的干预期间接受 CRC 筛查的女性人数，并使用索赔进行评估。结果 MMCO 工作人员通过电话联系了干预组中 60% 的女性。尽管参与干预组的女性 (36.7%) 明显多于常规护理组 (30.6%) 接受 CRC 筛查（比值比 [OR] = 1.32；95% CI，1.08-1.62），但参与 MMCO 的增加幅度从 1.1% 到 13.7% 不等，总体增加是由 1 MMCO 的增加推动的。在治疗比较中，通过电话联系的干预组中有 41.8% 的女性接受了 CRC 筛查，而在研究期间没有联系的常规护理组中，这一比例为 26.8%（OR = 1.84；95% CI，1.38，2.44）；需要通过电话联系 7 名女性，其中 1 名才能接受筛查。 结论 MMCO 工作人员提供的电话外展干预措施使随机女性中的 CRC 筛查率比常规护理提高了 6%，并且在干预所覆盖的先前逾期妇女中比常规护理提高了 15.1%。我们基于研究的干预措施已成功转化为健康计划领域，在参与的 MMCO 中产生了不同的效果。
PURPOSE Health Plans are uniquely positioned to deliver outreach to members. We explored whether telephone outreach, delivered by Medicaid managed care organization (MMCO) staff, could increase colorectal cancer (CRC) screening among publicly insured urban women, potentially reducing disparities.METHODS We conducted an 18-month randomized clinical trial in 3 MMCOs in New York City in 2008-2010, randomizing 2,240 MMCO-insured women, aged 50 to 63 years, who received care at a participating practice and were overdue for CRC screening. MMCO outreach staff provided cancer screening telephone support, educating patients and helping overcome barriers. The primary outcome was the number of women screened for CRC during the 18-month intervention, assessed using claims.RESULTS MMCO staff reached 60% of women in the intervention arm by telephone. Although significantly more women in the intervention (36.7%) than in the usual care (30.6%) arm received CRC screening (odds ratio [OR] = 1.32; 95% CI, 1.08-1.62), increases varied from 1.1% to 13.7% across the participating MMCOs, and the overall increase was driven by increases at 1 MMCO. In an as-treated comparison, 41.8% of women in the intervention arm who were reached by telephone received CRC screening compared with 26.8% of women in the usual care arm who were not contacted during the study (OR = 1.84; 95% CI, 1.38, 2.44); 7 women needed to be reached by telephone for 1 to become screened.CONCLUSIONS The telephone outreach intervention delivered by MMCO staff increased CRC screening by 6% more than usual care among randomized women, and by 15.1% more than usual care among previously overdue women reached by the intervention. Our research-based intervention was successfully translated to the health plan arena, with variable effects in the participating MMCOs.