Client (Patient) Reminder Planning Guide

This evidence-based intervention (EBI) is a message advising a patient that he or she is due for a cancer screening test. Patient reminders can be written messages (letter, postcard, email, or text) or a telephone call made by a person or an automated service. The goal is to prompt patients to schedule an appointment for screening.

Process Flow

Implement and integrate a patient reminder system into the clinic workflow.

When a reminder is sent and received, the patient is prompted to action.

Output: Increased screening prompts to patients.

Measure: Delivery of reminders

Example: Number of patients given reminders divided by the number of patients due for screening

Example: Number of patients who received reminders divided by the number of patients due for screening

Patient schedules and keeps an appointment for cancer screening.

Potential challenges include a limited electronic health record system, limited staff time if reminders are not automated, and incomplete records or incorrect contact information.

Output: Increased screening appointments by patients.

Measure: Appointments among eligible patients

Example: Number of patients scheduled for screening appointments divided by the number of patients receiving reminders

Example: Number of patients showing up for screening appointments divided by the number of patients scheduled

Patient completes cancer screening.

Potential challenges include inconvenient clinic hours, limited capacity or resources to follow-up on abnormal screening results, patient fear, cost, and lack of transportation.

Outcome: Increased screening and diagnostic tests completed by patients.

Measure: Screening completion

Example: Number of patients completing screening divided by the number of patients referred for screening

Example: Number of patients completing diagnostic follow-up divided by the number of patients with positive screening tests

Increased cancer screening.

Outcome: Increased clinic-level rates of cancer screening.

Measure: Age-eligible clinic population up-to-date with recommended cancer screening

Example: Uniform Data System (UDS), Healthcare Effectiveness Data Information Set (HEDIS), National Quality Forum (NQF) 12-month measure used to calculate screening rate

Top of Page

Community Guide Recommendation

The Community Preventive Services Task Force (Task Force) recommends the use of patient (client) reminders to increase screening for breast, cervical, and colorectal cancer.²

Settings Where Intervention Was Studied¹

Rural, urban, and suburban areas in the United States and Australia.
Primary care clinics and hospitals, Veterans Administration clinics, health maintenance organizations, local health departments, mobile mammography units, and patients’ homes.

Outcomes from the Systematic Review of Effectiveness¹

Screening

Completed mammography for breast cancer screening increased by a median of 12.3 percentage points; 6.0 percentage points for repeat (re-screening) mammography.
Completed cervical cancer screening tests increased by a median of 10.2 percentage points; 2.8 percentage points for a repeat test.
Completed fecal occult blood tests (FOBTs) for colorectal cancer screening increased by a median of 11.5 percentage points.

Cost of the Intervention per Participant

For mammography, the average cost per participant was less than $1.50.
For FOBT, the average cost per participant was less than $3.50 for mailed reminders and less than $60 for telephone reminders.

Components of the Intervention

Identify Patients Due for Screening Tests

Was a priority population defined?
Were the characteristics of the priority population and their barriers assessed?
Have patients who are due for screening identified using the EHR or other patient record system?

Develop and Send Reminder

Will the reminder be a phone call, e-mail, letter, postcard, or text message?
Was the date that determined screening eligibility included? In other words, is screening due based on aging into eligibility or the date of the patient’s last test?
Is up-to-date contact information for the patients available? Is the type of contact information appropriate for the mode of reminder selected?
Is the language used for the reminder appropriate for the recipient?
Have administrative staff been told when the reminders will be sent so they can prepare for increased call volume? Have they been trained on any new processes?

Track Outcomes

Are the means and data to track patients through screening and diagnostic test completion available?
Have methods and tools for tracking been identified or created?
Have appropriate and feasible performance measures for process and outcome evaluation been selected?

Resources to Support Implementation

Partnerships

Internal: across and within clinics, with departments such as billing, claims, radiology, and information technology (IT).
External: patient registries, laboratories, community health workers, volunteers, and academics.

Staff

Administrative support to identify patients due for screening, draft the content of the reminder, send the reminders (if the process is not automated), collect data, and track reminders and test results.

Tools

Computerized patient registry or electronic health records (EHR) to identify patients due for screening and record responses to reminders.
Reminder content can include responses to common screening barriers.
Appointment scheduling system.
Assessments of effectiveness.

Lessons Learned from the Literature¹

The effect was larger for telephone reminders than for written reminders for breast and cervical cancer.
When used as part of a multicomponent approach to increase cancer screening rates, the median increase across multiple studies attributed to the patient reminders was 5.0 percentage points for breast cancer, 3.7 percentage points cervical cancer, and 10.9 percentage points for colorectal cancer.
Simple reminders were more effective for patients who have been screened before.
Reminder letters were less effective when multiple barriers to screening existed.
The reminder system can range from simple to highly complex. More complex systems require greater coordination of staff and processes.
Funds may be required to start systems and generate and deliver reminders, but programs implemented on a large scale may decrease the cost per person.
Interviews about barriers and facilitators to screening in priority populations can inform effective messaging for follow-up reminders.
In one longer-term study, the effect achieved after year 1 diminished over time and disappeared by year 3, suggesting that systems may need periodic adjustment or enhancement to maintain effectiveness.

Ways to Strengthen Performance or Sustainability

Assess the priority population to inform message development and refinement.
Send additional follow-up reminders.
Provide additional information about cancer, screening tests, and resources to overcome screening barriers.
Help schedule appointments.

References

¹Sabatino SA, Lawrence B, Elder R, Mercer SL, Wilson KM, DeVinney B, Melillo S, Carvalho M, Taplin S, Bastani R, Rimer BK, Vernon SW, Melvin CL, Taylor V, Fernandez M, Glanz K, Community Preventive Services Task Force. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for The Guide to Community Preventive Services. American Journal of Preventive Medicine 2012;43(1):765–786.

²Community Preventive Services Task Force. Updated recommendations for client- and provider-oriented interventions to increase breast, cervical, and colorectal cancer screening. American Journal of Preventive Medicine 2012;43(1):92–96.