Five-Year Follow-Up Of A Nurse-Initiated Intervention To Improve Mammography Recommendation

Abstract

Background: In a previous study we found immediate effectiveness of a nurse-initiated intervention on improving mammography recommendation rates in a family practice residency program. To determine the long-term effectiveness of this ongoing intervention, we performed a chart audit study on two different groups of charts 5 years after the institution of the intervention.

Methods: Chart audits for mammogram recommendation and completion rates were conducted on an original cohort group of women aged 40 years and older (n = 91) and a new 5-year postintervention group of women aged 53 years and older (n = 189). Preintervention, postintervention, and 5-year postintervention rates were compared within the cohort group. Rates of the new 5-year postintervention group were compared with rates of women 50 years and older from the original pre intervention group and postintervention group.

Results: For the original cohort group the improvement in “mammograms done at least once in the past 3 years” was maintained 5 years later, and there was a statistically significant increased rate from the postintervention to 5 years later (73.9 percent versus 86.8 percent, P<0.02) for “mammograms done or recommended at least once in the past 3 years.” This improvement was also noted for the new 5-year postintervention group when their rates were compared with the pre intervention and postintervention group rates. For “mammograms done at least once in the past 3 years,” the rates were 34.2 percent, 45.5 percent, and 64 percent, respectively. For “mammograms done or recommended at least once in the past 3 years,” the rates were 42.6 percent, 72.7 percent, and 90.0 percent, respectively. In a separate analysis, annual mammogram rates in the new 5-year postintervention group for the 3 years preceding this study were 44.8 percent (1990), 36.5 percent (1991), and 36.5 percent (1992). Eleven percent of women had a mammogram done in each of the 3 consecutive years.

Conclusion: An ongoing nurse-initiated intervention is a feasible method of improving and maintaining mammogram recommendation and completion rates. Further studies of interventions to improve the rate at which eligible women get consecutive annual mammograms are needed.