Improving Mammography Screening Using Best Practices and Practice Enhancement Assistants: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

Cheryl B. Aspy; Margaret Enright; LaWanna Halstead; James W. Mold

doi:10.3122/jabfm.2008.04.070060

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Table 1.

Methods Used By Primary Care Clinician Exemplars to Achieve High Rates of Mammography Screening in Their Patients

1. Make a commitment to provide prevention services, both personally and as a practice, focusing on the most important preventive services and making sure that all eligible patients are offered those services. Think about preventive services at every visit with every patient. Suggestions for critical adult preventive services include:

Colorectal cancer screening for all ages 50 and older;
Mammography for women beginning at age 40;
Cervical cancer screening for women ages 18 to 65;
Influenza vaccination for all ages 50 and older and anyone else who wants it;
One-time pneumococcal vaccination for all ages 50 and older.

2. Use a clinician/nurse reminder system of some type such as:

Preventive services flow sheet;
Special mammography stickers for women older than 40;
Preventive services reminder card that nurses complete.

3. Make the mammography appointment for the patient. (Don't ask the patient to do it.) Caveats include:

Ask the patient what day and time would be best (before they leave the office) so that the appointment made by your office will be convenient for them;
Discuss potential barriers with patients who have missed or delayed their mammograms and ask them what it would take to get them in for their mammography.

4. Use only 1 mammography center for almost all of your patients. Select the referral center based on the following:

Appointments should generally be available within 2 weeks;
Mammography center should always send a report to the patient and to you;
Mammography center should let you know when patients miss their scheduled appointment;
Mammography center should send a reminder to the patient every year (or as indicated);
Mammography center should do further testing without bothering you for additional orders.

5. Schedule well adult examinations on a regular basis to catch up on any preventive services that have been missed.

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Table 2.

Methods Used by Intervention Practices to Improve Mammography Screening

Clinician	Rate Before/After Intervention (%)	Method 1	Method 2	Method 3	Method 4	Method 5
A	28/71	Very committed to prevention	Nurses check chart at each visit for all prevention services needed	Appointment was made at check-out	Appointments were tracked and followed up if not kept
B	48/75	Very committed to prevention	Nurses checked mammogram eligibility at each visit	Referral was made at check-out	Appointments were tracked and followed up if not kept
C	35/56	Very committed to prevention	Nurses checked mammogram eligibility at each visit	Appointment was made at check-out	Used one referral center
D	35/52	Very committed to prevention	Nurses checked mammogram eligibility at each visit	Referral was made at check-out		Women eligible for a mammogram were contacted for an appointment
E	62/70	Very committed to prevention	Nurses asked eligible women about mammography	Referral was made at check-out
F	25/28	Prevention was not a priority	Nurses asked eligible women about mammography	Referral was made at check-out
G	56/56	Committed to prevention	Nurses checked mammogram eligibility at each visit	Referral was made at check-out
H	21/21	Prevention was not a priority			Used one center but expected patients to self-refer

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Table 3.

Comparison of Usual Care and Intervention Practices' Demographic Characteristics and Outcomes Before and After Intervention

	Usual Care Practices (n = 8)^*		Intervention Practices (n = 8)^†		P
	Before	After	Before	After	P
Patient age^‡	x̄ = 66.3; s = 3.8	x̄ = 67.2; s = 3.1	x̄ = 66.9; s = 3.26	x̄ = 65.6; s = 2.5	>.05
Insurance status (%)
Private	36	34	37	39	>.05
All other	64	66	63	61
Current mammogram (%)^‡	40	35	40	52	.015

* Total patients of usual care group before interevention, 688; after intervention, 576.
† Total patients of intervention group, before intervention, 678; after intervention, 639.
‡ t test of change scores.