POPULATION BASED APPROACH TO INCREASE MAMMOGRAPHY USE

这项提议旨在测试以下各项的有效性和成本效益 两项邮寄的以人口为基础的干预措施，旨在增加 在医疗服务不足的40至84岁女性中使用乳房X光检查。两者都有 干预措施旨在促进乳房X光检查服务的使用 可通过两个国家计划提供：疾病控制中心 和预防(CDC)全国乳腺癌和宫颈癌早期 检测计划(Nbccedp)和联邦医疗保险。一次干预使用 亲自写信鼓励女性做乳房X光检查， 而另一种干预使用了个人地址的组合 邮件、免费电话和直接预约日程安排 鼓励女性做乳房X光检查。因为与年龄有关的差异 在使用乳房X光检查的保险覆盖范围和障碍方面 正如数据的可用性以充分测量乳房X光照相使用一样， 这项建议分为两项研究。一项研究针对更年轻的人 年龄在40岁至之间的女性，通过 明尼苏达州的nbccedp，而另一项研究的目标是65岁的老年女性 至84名有资格通过以下任一途径获得乳房X光检查服务的人 明尼苏达州的nbccedp或联邦医疗保险。研究样本将是随机的 摘自明尼苏达州驾照数据库，用于研究 年轻女性，以及从联邦医疗保险的注册文件中研究 年长的女人。共有15,201名年龄在40-之间的女性和7,134名年龄在 65-84将随机分配到两个干预组中的一个或一个 对照组。随机后测的控制组设计将 被用来测试女性在接受治疗的比例上的差异 根据索赔数据收到邮件一年后进行乳房X光检查 来自州计划和/或联邦医疗保险。如果这项研究能证明 增加乳房X光检查使用量的低成本策略的有效性 在服务不足的人群中，它可以极大地促进 实现国家公共卫生目标，改善所有人的健康 女人。广泛纳入拟议的 干预措施是实质性的，因为它们的设计很容易 由州和地方卫生部门实施。

This proposal seeks to test the effectiveness and cost-effectiveness of two mailed, population-based interventions designed to increase mammography use among medically underserved women age 40 to 84. Both interventions are designed to promote use of mammography services available through two national programs: the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and Medicare. One intervention uses personally addressed mailings to encourage women to get a mammogram, while the other intervention uses a combination of personally addressed mailings, a toll-free number, and direct appointment scheduling to encourage women to get a mammogram. Because of age-related differences in both insurance coverage for and barriers to mammography use, as well as in the availability of data to adequately measure mammography use, this proposal is divided into two studies. One study targets younger women age 40 to 64 who are eligible for mammography services through the NBCCEDP in Minnesota, while the other study targets older women age 65 to 84 who are eligible for mammography services through either Minnesota's NBCCEDP or Medicare. The study samples will be randomly drawn from the Minnesota driver's license database for the study of younger women, and from Medicare's enrollment file for the study of older women. A total of 15,201 women age 40-64 and 7,134 women age 65-84 will be randomly assigned to one of two intervention groups or a control group. A randomized post-test only control group design will be used to test for differences in the proportion of women getting a mammogram one year after receiving the mailings based on claims data from the state program and/or Medicare. If this study can demonstrate the effectiveness of a low-cost strategy for increasing mammography use among underserved populations, it can significantly contribute to reaching national public health goals for improving the health of all women. The potential for widespread incorporation of the proposed interventions are substantial because they are designed to be readily implemented by state and local health departments.