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A Randomized Trial of Intensive Case Management

Barbara E. Weber, MD, MPH; Brendan M. Reilly, MD

Arch Intern Med. 1997;157(20):2345-2349.

Abstract
Background
Breast cancer screening with mammography is an effective intervention for women aged 50 to 75 years but it is underused, especially by the urban poor.

Objective
To improve mammography completion rates for urban women aged 52 to 77 years who had not had a mammogram in at least 2 years.

Methods
We conducted a randomized controlled trial of a case management intervention by culturally sensitive community health educators vs usual care in 6 primary care practices supported by a computerized clinical information system.

Results: Women in the intervention group were nearly 3 times as likely to receive a mammogram (relative risk, 2.87; 95% confidence interval, 1.75-4.73). The benefit persisted when analyzed by age, race, and prior screening behavior. This intervention was practice based, not dependent on visits, and enhanced the efficacy of an already successful computerized preventive care information system.

Conclusions
Personalized education and case management are successful in enhancing compliance with breast cancer screening among historically noncompliant vulnerable urban women. This intervention, when combined with a preventive care information system, has the potential to achieve Healthy People 2000 objectives for breast cancer screening.

Arch Intern Med. 1997;157:2345-2349

Author Affiliations
From the University of Rochester School of Medicine and Dentistry, St Mary's Hospital, Rochester, NY (Dr Weber), and Rush Medical College, Cook County Hospital, Chicago, Ill (Dr Reilly).

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