TY - JOUR
T1 - The efficacy of direct mail, patient navigation, and incentives for increasing mammography and colonoscopy in the medicaid population
T2 - A randomized controlled trial
AU - Slater, Jonathan S.
AU - Parks, Michael J.
AU - Nelson, Christina L.
AU - Hughes, Kelly D.
N1 - Funding Information:
Funding was provided by the HHS Centers for Disease Control and Prevention (#U58DP003922), received by J. Slater, and supported all authors.
Publisher Copyright:
© 2018 American Association for Cancer Research.
PY - 2018/9
Y1 - 2018/9
N2 - Background: Despite lower cancer screening rates and survival rates in the Medicaid population compared with those with private insurance, there is a dearth of population-based, evidence-based interventions targeting Medicaid clients to address this problem. Methods: This study reports results of a population-based randomized controlled trial (RCT) among all individuals enrolled in Minnesota's Medicaid program who were overdue for breast cancer (n = 22,113) and/or colo-rectal cancer (n = 94,294) screening. Individuals were randomized to intervention or control groups. The intervention group received persuasive and innovative direct mail materials coupled with a $20 incentive for using their Medicaid benefit to get screened. Direct mail materials provided a phone number to a call center staffed by patient navigators who addressed barriers and scheduled appointments via three-way calls. The control group received the intervention 15 months later. Primary outcomes were completion of mammography or colonoscopy within 12 weeks of the intervention. Billing claims served as evidence of screening. Results: Multivariate logistic regression showed significant differences for both breast cancer (P < 0.001) and colorectal cancer (P < 0.01). The odds of receiving a mammogram for the treatment group were significantly higher than the control group [OR= 1.30; 95% confidence interval (95% CI) = 1.16-1.46], and the treatment group was more likely to receive a colonoscopy than the control group (OR = 1.12; 95% CI = 1.04-1.21). Conclusions: This population-based intervention increased breast cancer and colorectal cancer screening in a Medicaid population overdue for screening. Impact: These findings may have broad application for reaching individuals who generally remain outside the health care system despite having public health insurance.
AB - Background: Despite lower cancer screening rates and survival rates in the Medicaid population compared with those with private insurance, there is a dearth of population-based, evidence-based interventions targeting Medicaid clients to address this problem. Methods: This study reports results of a population-based randomized controlled trial (RCT) among all individuals enrolled in Minnesota's Medicaid program who were overdue for breast cancer (n = 22,113) and/or colo-rectal cancer (n = 94,294) screening. Individuals were randomized to intervention or control groups. The intervention group received persuasive and innovative direct mail materials coupled with a $20 incentive for using their Medicaid benefit to get screened. Direct mail materials provided a phone number to a call center staffed by patient navigators who addressed barriers and scheduled appointments via three-way calls. The control group received the intervention 15 months later. Primary outcomes were completion of mammography or colonoscopy within 12 weeks of the intervention. Billing claims served as evidence of screening. Results: Multivariate logistic regression showed significant differences for both breast cancer (P < 0.001) and colorectal cancer (P < 0.01). The odds of receiving a mammogram for the treatment group were significantly higher than the control group [OR= 1.30; 95% confidence interval (95% CI) = 1.16-1.46], and the treatment group was more likely to receive a colonoscopy than the control group (OR = 1.12; 95% CI = 1.04-1.21). Conclusions: This population-based intervention increased breast cancer and colorectal cancer screening in a Medicaid population overdue for screening. Impact: These findings may have broad application for reaching individuals who generally remain outside the health care system despite having public health insurance.
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U2 - 10.1158/1055-9965.EPI-18-0038
DO - 10.1158/1055-9965.EPI-18-0038
M3 - Article
C2 - 29891726
AN - SCOPUS:85053055882
SN - 1055-9965
VL - 27
SP - 1047
EP - 1056
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 9
ER -