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A Randomized Controlled Trial

Steven R. Simon, MD, MPH; Fang Zhang, PhD; Stephen B. Soumerai, ScD; Arthur Ensroth, MPH; Lydia Bernstein, MPH; Robert H. Fletcher, MD, MSc; Dennis Ross-Degnan, ScD

Arch Intern Med. 2010;170(3):264-270.

Background  Automated telephone outreach with speech recognition (ATO-SR) is used extensively by health plans. Whether ATO-SR can increase rates of colorectal cancer (CRC) screening is unknown.

Methods  We randomly allocated 40 000 health plan members to ATO-SR and 40 000 to usual care, of whom 10 432 and 10 506 in the intervention and usual care groups, respectively, had not been previously screened and were therefore eligible for analysis. The intervention was a single interactive outreach call using speech recognition to engage participants in conversation about the importance of CRC screening and options for and barriers to screening. The intervention directed participants to contact their primary care provider to schedule screening. The primary end point was any CRC screening in the year following intervention. Colonoscopy in the year following intervention was a secondary outcome.

Results  The incidence of any CRC screening was 30.6% in the intervention group and 30.4% in the usual care group (P = .76). After adjustment for available covariates, there remained no intervention effect (adjusted odds ratio [OR], 1.01; 95% confidence interval [CI], 0.94-1.07). A total of 21.4% of members in the intervention group and 20.3% in the usual care group underwent colonoscopy (P = .04). In multivariate analysis, there was a small intervention effect on colonoscopy (OR, 1.08; 95% CI, 1.00-1.16).

Conclusions  This study showed that ATO-SR failed to improve rates of CRC screening. Future studies should examine approaches that combine efforts to target patients and their health care providers to overcome the barriers to CRC screening.

Trial Registration  clinicaltrials.gov Identifier: NCT00792285

Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Simon, Zhang, Soumerai, Fletcher, and Ross-Degnan); and Clinical Programs and Quality Measurement, Harvard Pilgrim Health Care, Wellesley, Massachusetts (Mr Ensroth and Ms Bernstein).

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