POPULATION BASED APPROACH TO INCREASE MAMMOGRAPHY USE

本建议旨在测试以下措施的成效和成本效益： 两个邮寄的，以人口为基础的干预措施，旨在增加 乳房X光检查在医疗服务不足的40至84岁妇女中的使用。 两 干预措施的目的是促进使用乳房X光检查服务， 可通过两个国家计划获得：疾病控制中心 美国疾病控制与预防中心（CDC）全国乳腺癌和宫颈癌早期 检测计划（NBCCEDP）和医疗保险。 一种干预措施使用 亲自发邮件鼓励女性去做乳房X光检查， 而另一种干预则使用个人寻址 邮件，免费电话号码，和直接预约安排， 鼓励女性做乳房X光检查。 由于年龄差异 在乳房X光检查的保险范围和使用障碍方面， 如在充分测量乳房X线照相术使用的数据的可用性方面， 这项建议分为两项研究。 一项研究针对年轻人 年龄在40至64岁之间的妇女，有资格通过 明尼苏达州的NBCCEDP，而另一项研究则针对65岁的老年妇女 84人有资格通过以下方式获得乳房X光检查服务： 明尼苏达州的NBCCEDP或医疗保险。 研究样本将随机 从明尼苏达州的驾驶执照数据库中提取，用于研究 年轻女性，并从医疗保险的登记档案的研究， 年纪大的女人 共有15 201名40-64岁的妇女和7 134名 65-84将被随机分配到两个干预组之一或一个 对照组 一个随机化的后测对照组设计将 被用来测试女性获得A 在收到基于索赔数据的邮件一年后进行乳房X光检查 从国家计划和/或医疗保险。 如果这项研究能证明 提高乳房X线摄影使用率的低成本策略的有效性 在服务不足的人群中，它可以大大有助于 实现改善全民健康的国家公共卫生目标 妇女 广泛纳入拟议的 干预措施是实质性的，因为它们的设计是为了 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.