Findings of a new Mayo Clinic study published this week in Archives of Internal Medicine show that a computerized mail and phone reminder program can significantly increase the percentage of patients receiving preventive health services and improve the value of health care.
"National evidence-based guidelines say every woman over age 40 should have a yearly mammogram, but only about 65 percent of women nationally have had one in the last two years," explains Rajeev Chaudhry, M.B.B.S., the Mayo Clinic physician who led the study. "In this study we showed we can increase that percentage through a team approach, and we're applying the findings to other chronic disease and preventive services, too."
The researchers divided a population of 6,675 women aged 40--75 into two nearly equal groups: one to get mailings and, if necessary, a phone call to remind them to schedule a mammogram; and a control group that did not receive reminders. Among the reminded group, 64.3 percent had their yearly mammogram, compared to 55.3 percent in the control group. As the program has expanded following the study period, compliance with yearly mammograms has now grown to over 72 percent, with 86 percent having had one within the previous two years.
Dr. Chaudhry said a redesign of the primary care practice to enable appointment secretaries to schedule preventive services was a key to the program's success.
"In the old way, a woman had to remember that it was time for her yearly mammogram and call her physician's appointment secretary, who then got the doctor's approval for the test," he explains. "Then the secretary had to get back in touch with the woman to schedule the mammogram. That made the process more complicated, time-consuming and expensive than it needs to be, with several places where missed communication could mean the test didn't get done. With our new electronic tool and our related practice changes, one appointment secretary can now schedule mammography for over 10,000 women. When women get the reminder notice, it means they are preapproved, so the mammography can be scheduled with the first phone call without having to consult the physician."
"Not everyone needs to see a doctor every year, but they still should get the appropriate preventive care and screenings," explains Robert Stroebel, M.D., chair, Division of Primary Care Internal Medicine at Mayo Clinic and the study's senior author. "We were pleasantly surprised at how much we could increase mammography percentages through this new system. As we get more women screened, we're also going to find cancers earlier, when we're more likely to be able to treat them successfully. The goal is to improve the value of heath care, providing higher quality at lower cost by having all members of the health care team working at their highest potential," Dr. Stroebel says. "We already have expanded this reminder method to Pap smears and diabetes care, and will be adding other preventive services this year."
"This kind of practice happens in other fields," says co-author Rosa Cabanela. "Dentist practices, for example, typically call or mail patients to remind them to make an appointment. Health care has been behind many other industries in using technology to optimize service and efficiency. It's time to catch up."
Dr. Chaudhry says the study has important implications in designing better care delivery systems. "With baby boomers getting older and having more chronic conditions, it's estimated that a primary care physician may have to spend up to six hours a day managing the preventive services and chronic disease tests for his or her patient population," he says. "By using information technology and a team approach to manage chronic and preventive care, we can free physicians to focus on the individualized needs of their patients."
Other members of the team who are co-authors of the paper include Sidna Scheitel, M.D.; Erin McMurtry; Dorinda Leutink; James Naessens, Sc.D.; Ahmed Rahman; and Lynn Davis.
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