Evaluation of Three Methods for Improving Mammography Rates in a Managed Care Plan

Mammography has been shown to reduce breast cancer mortality among women 50 and older. Although mammography rates are increasing nationally, this effective screening tool remains underused. This study was conducted among 395 women who were members of a network model health maintenance organization (HMO) in Philadelphia in order to determine which of three methods was most effective in increasing mammography rates: (1) a birthday card reminder only (the standard method); (2) a personalized letter from the medical director and materials promoting mammography; and (3) a multicomponent phone call incorporating a reminder, counseling, and scheduling of appointments. An additional goal was to determine whether the interventions were more or less effective depending on a woman’s readiness to get a mammogram, as measured by stage of change. Eligible women were randomized into one of three treatment groups described earlier. Mammography rates were calculated on the basis of a claims review and follow-up phone interviews after a period of six months. Women who received the telephone intervention were most likely to obtain a mammogram (28%), followed by the group that received the birthday card only (15%), and those who received the mailed intervention (9%). These results indicate that a multicomponent phone intervention is significantly effective in promoting mammography in managed health care plan members. An analysis by women’s stage of change found a difference in the effectiveness of the three interventions among contemplators only.