Promoting Cancer Screening Among Medicaid Recipients in Minnesota
Condition: Colorectal Cancer; Breast Cancer
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      This study evaluates the effectiveness of persuasive direct mail materials coupled with an
      incentive for increasing breast and colorectal cancer screening among people enrolled in
      Medicaid. Half of age- and gender-appropriate enrollees received this intervention; the other
      half received the same intervention 15 months later
    

Detailed description: 
      This trial was conducted between April 2014 and July 2015 and implemented through Sage, the
      National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Minnesota and housed
      within the Minnesota Department of Health (MDH). The target population was all Minnesota
      Medicaid recipients ages 50-74 overdue for breast cancer and colorectal cancer screening.
      Claims data, obtained from MDHS, were used to determine patient characteristics and outcomes.
      Individuals who were not enrolled in Medicaid, who were not overdue for BC or CRC screening,
      or who were not in the 50-74 age range were excluded prior to analysis.

      To determine the efficacy of the interventions we used a two group posttest-only randomized
      design with all eligible MA beneficiaries randomly assigned to one of two groups: Direct Mail
      plus Incentive (with patient navigation) versus usual care.

      The primary outcomes were completion of mammography or colonoscopy within 12 weeks after
      implementation of the intervention. Current Procedural Technology (CPT) codes from Medicaid
      claims data were used to determine if an individual had received either mammography or
      colonoscopy. Specific CPT codes used for mammography were conventional mammography
      (77055-77057), digital mammography (G0202, G0204, G0206), and computer-aided detection
      mammography (77051, 77052). CPT codes used for colonoscopy were G0105, G0121, 45378, and
      45380-45385. Mammography and colonoscopy outcomes were measured dichotomously. Outcomes were
      based on the presence of screening mammography and colonoscopy claims occurring for 10 weeks
      after the first mailings.

      The mammography and colonoscopy interventions were examined separately. Across treatment and
      control, study sample characteristics were compared and absolute differences were assessed
      using t-test and χ2 statistics. Main outcome analyses consisted of logistic regression to
      compute odds ratios for receiving mammography or colonoscopy and for covariate adjustment.
      Two separate logistic regression models were examined for both mammography and colonoscopy
      interventions: (1) a bivariate model that examined treatment versus control, and 2) a
      multivariate model that adjusted for covariates. All analyses were conducted using Stata,
      version 13.

      Some individuals lost Medicaid coverage on a monthly basis during the study period, and
      others had inaccurate mailing addresses (< 2% of each study sample). Therefore not everyone
      received the treatment as intended, and individuals that received the intervention may not
      have had Medicaid claims available post-intervention. Our outcome analyses were
      intent-to-treat analyses that included all individuals randomized to treatment or control
      groups at initiation of intervention regardless of whether they lost coverage
      post-randomization or if they had an inaccurate mailing address.
    

Intervention name(s): Mammography direct mail coupled with a financial incentive; Usual care; Colonoscopy direct mail coupled with a financial incentive
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The intervention groups received innovative and persuasive direct mail materials coupled with an incentive for using their Medicaid benefit to get screened.; Group received usual care, and direct mail 15 months after treatment group received intervention.; The intervention groups received innovative and persuasive direct mail materials coupled with an incentive for using their Medicaid benefit to get screened.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Health Services Research
Keywords: cancer screening