Dataset Information

Population-based breast cancer screening in a primary care network.

ABSTRACT: To assess the ability of a health information technology system to facilitate population- based breast cancer screening.Cohort study with 2-year follow-up after a 1-year cluster randomized trial.Study population was women 42 to 69 years old receiving care within a 12-practice primary care network. The management informatics system (1) identified women overdue for mammograms, (2) connected them to primary care providers using a web-based tool, (3) created automatically generated outreach letters for patients specified by providers, (4) monitored for subsequent mammography scheduling and completion, and (5) provided practice delegates with a list of women remaining unscreened for reminder phone calls. Eligible women overdue for a mammogram during a 1-year study period included those overdue at study start (prevalent cohort) and those who became overdue during follow-up (incident cohort). The main outcome measure was mammography completion rates over 3 years.Among 32,688 eligible women, 9795 (30%) were overdue for screening (4487 intervention, 5308 control). Intervention patients were somewhat younger, more likely to be non-Hispanic white, and more likely to have health insurance compared with control patients. Adjusted completion rates in the prevalent cohort (n = 6697) were significantly higher among intervention patients after 3 years (51.7% vs 45.8%; P = .002). For patients in the incident cohort (n = 3098), adjusted completion rates after 2 years were 53.8% versus 48.7%, respectively (P = .052).Population-based informatics systems can enable sustained increases in mammography screening rates beyond rates seen with office-based visit reminders.

SUBMITTER: Atlas SJ

PROVIDER: S-EPMC3766952 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

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Population-based breast cancer screening in a primary care network.

Atlas Steven J SJ Ashburner Jeffrey M JM Chang Yuchiao Y Lester William T WT Barry Michael J MJ Grant Richard W RW

The American journal of managed care 20121201 12

<h4>Objectives</h4>To assess the ability of a health information technology system to facilitate population- based breast cancer screening.<h4>Study design</h4>Cohort study with 2-year follow-up after a 1-year cluster randomized trial.<h4>Methods</h4>Study population was women 42 to 69 years old receiving care within a 12-practice primary care network. The management informatics system (1) identified women overdue for mammograms, (2) connected them to primary care providers using a web-based too ...[more]

PMID: 23286611

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Project description:BackgroundInformation technology offers the promise, as yet unfulfilled, of delivering efficient, evidence-based health care.ObjectiveTo evaluate whether a primary care network-based informatics intervention can improve breast cancer screening rates.DesignCluster-randomized controlled trial of 12 primary care practices conducted from March 20, 2007 to March 19, 2008.PatientsWomen 42-69 years old with no record of a mammogram in the prior 2 years.InterventionsIn intervention practices, a population-based informatics system was implemented that: connected overdue patients to appropriate care providers, presented providers with a Web-based list of their overdue patients in a non-visit-based setting, and enabled "one-click" mammography ordering or documented deferral reasons. Patients selected for mammography received automatically generated letters and follow-up phone calls. All practices had electronic health record reminders about breast cancer screening available during clinical encounters.Main measuresThe primary outcome was the proportion of overdue women undergoing mammography at 1-year follow-up.Key resultsBaseline mammography rates in intervention and control practices did not differ (79.5% vs 79.3%, p = 0.73). Among 3,054 women in intervention practices and 3,676 women in control practices overdue for mammograms, intervention patients were somewhat younger, more likely to be non-Hispanic white, and have health insurance. Most intervention providers used the system (65 of 70 providers, 92.9%). Action was taken for 2,652 (86.8%) intervention patients [2,274 (74.5%) contacted and 378 (12.4%) deferred]. After 1 year, mammography rates were significantly higher in the intervention arm (31.4% vs 23.3% in control arm, p < 0.001 after adjustment for baseline differences; 8.1% absolute difference, 95% CI 5.1-11.2%). All demographic subgroups benefited from the intervention. Intervention patients completed screening sooner than control patients (p < 0.001).ConclusionsA novel population-based informatics system functioning as part of a non-visit-based care model increased mammography screening rates in intervention practices.Trial registrationClinicalTrials.gov; NCT00462891.

Project description:BackgroundDespite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known.ObjectiveTo characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH).DesignWeb and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening.ParticipantsPrimary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers.Main measuresThe prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up.Key resultsThere were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guideline-adherent breast (OR 3.23, 95 % CI 1.58-6.61) or cervical (OR 2.56, 95 % CI 1.32-4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 % CI 1.15-41.7) or cervical (OR. 2.56, 95 % CI 1.26-5.26) cancer screening.ConclusionsProviders lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline-adherent cancer screening in primary care settings.

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Population-based breast cancer screening in a primary care network.

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Population-based breast cancer screening in a primary care network.

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