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A System Intervention to Improve Mammography Re-Screening in Community Clinics: Predictors and Outcomes

Regina Otero-Sabogal, PhD1, Desi Owens, MS, LCSW1, Jesse A. Canchola, MS1, Farzaneh Tabnak, MS, PhD2, and Patrick J. Fox, PhD1. (1) Institute for Health and Aging, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA 94118, 415-476-3311, reginas@itsa.ucsf.edu, (2) Cancer Detection Section, California Department of Health Services, 1616 Capital Avenue, Suite 74.421, MS-7203, P.O. Box 997413, Sacramento, CA 95899-7413

Background: Given the multiple barriers on the clinic, provider, and patient levels, mammography re-screening rates are low among uninsured women. This study re-designed clinic screening practices through a multi-faceted intervention that included: 1) clinic assessments and feedback; 2) tracking systems; 3) reminder calls; 4) tailored patient education; and 5) physician prompts. The primary aim of the study was to increase patientsí mammography re-screening rates within three community clinics participating in a free state-wide mammography program, and to identify multi-level predictors of re-screening. Methods: We used a quasi-experimental design with a random selection of 447 patients at baseline. A comparable cross-sectional random sample was drawn at post-intervention. Chart reviews were conducted to establish re-screening rates. Results: Exact binomial proportion difference tests indicated significant improvements at Clinic 1 and Clinic 2 [baseline: 29.6% v. post-intervention: 46.1% (p=.003), and baseline: 38.9% v. post-intervention: 69.0% (p=.02) respectively]. At Clinic 3, where the baseline rate was the highest, there was a slight improvement in the re-screening rate following the intervention. However, this result was not statistically significant [baseline: 44.4% v. post-intervention: 48.0% (p=.60)]. Similar results were found for CBE re-screening. A stepwise multivariable logistic regression will be performed to identify substantive predictors of re-screening, and results will be reported. Conclusions: The most effective way to improve utilization of breast health services among the underserved is to implement tailored patient interventions, and system redesign.

Learning Objectives:

Keywords: Breast Cancer Screening,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Experiences of Cancer

The 132nd Annual Meeting (November 6-10, 2004) of APHA