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Use of Interactive Voice Response to Improve Colorectal Cancer Screening

Cohen-Cline, Hannah, MPH*,†; Wernli, Karen J., PhD*,‡; Bradford, Susan C., MPH; Boles-Hall, Mary, BA; Grossman, David C., MD, MPH*,‡,§

doi: 10.1097/MLR.0000000000000116
Brief Reports

Introduction: Only 63% of the US population aged 50–75 years is adherent with recommended colorectal cancer (CRC) screening guidelines. Efforts are needed to increase screening for CRC.

Methods: We evaluated a quality improvement intervention conducted in 2010 at Group Health in Washington State to assess the use of interactive voice response (IVR) systems to improve CRC screening. Eligible members were aged 50–81 years, received primary care from a contracted physician, and were due for CRC screening. A total of 13,279 members were identified and randomly assigned to either: (1) an intervention with IVR to encourage CRC screening (n=10,000), or (2) usual care (n=3279). The primary outcome was receipt of any recommended CRC screening test at 6 months postintervention or index date. We used Cox proportional hazards to model time until receipt of CRC screening at 6 months.

Results: Adherence to CRC screening was 10.0% in the intervention arm and 7.8% in the usual care arm at 6 months. Randomization to the IVR intervention arm was associated with a 32% increased likelihood of receiving CRC screening (hazard ratio=1.32; 95% confidence interval, 1.14, 1.52) compared with usual care. The difference in CRC screening uptake was apparent by 3 months and persisted for 12 months postintervention (log-rank test, P=0.0012).

Discussion: Our analysis provides “real-world” evidence that IVR is effective when delivered by a commercial health plan, and may be a useful tool for increasing adherence to screening guidelines among patients outside an integrated care practice.

*Group Health Research Institute

Departments of Epidemiology

Health Services, University of Washington

§Department of Clinical Improvement and Prevention, Group Health, Seattle, WA

D.C.G. is a shareholder in Group Health Physicians, which contracts exclusively with Group Health Cooperative to provide medical services. The remaining authors declare no conflict of interest.

Reprints: Karen J. Wernli, PhD, Group Health Research Institute, 1730Minor Ave, Suite 1600, Seattle, WA 98101. E-mail:

© 2014 by Lippincott Williams & Wilkins.