Impact of Phone-Call and Access-Enhancing Intervention on Mammography Uptake among Primary Care Patients at an Urban Saf
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Impact of Phone-Call and Access-Enhancing Intervention on Mammography Uptake among Primary Care Patients at an Urban Safety-Net Hospital: A Randomized Controlled Study Asha D. Nanda, BA1, Melissa P. Mann, RN2, An-Lin Cheng, PhD3, Jill Moormeier, MD, MPH2,4, and Nasim Ahmadiyeh, MD, PhD2,5,6 1
University of Missouri-Kansas City School of Medicine, Kansas City, MO; 2Truman Medical Centers, Kansas City, MO; Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO; 4Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO; 5Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO; 6Department of Surgery, Truman Medical Center, Kansas City, MO 3
ABSTRACT Background. Our urban safety-net hospital (SNH) has very low screening mammogram rates within its primary care clinics. Despite Commission on Cancer (CoC) accreditation, we see * 3 9 more late-stage breast cancer diagnoses than other CoC sites across the country, and recently showed this to be strongly associated with lack of screening (Ahmadiyeh et al. in J Health Care Poor Underserved, in press, 2020). Here we study whether a two-step intervention (phone calls and assistance scheduling mammograms) increases uptake over usual care. Patients and Methods. Randomized controlled study of 890 women aged 50–65 years who were due for biennial screening mammograms and who were established within one of five primary care clinics at an urban SNH. Each patient in the intervention group was called with overdue status (up to three times, voicemail left if needed) and offered assistance scheduling mammogram appointment. Mammography uptake at 3 and 6 months was analyzed. Results. Intervention significantly increased uptake compared with usual care at both timepoints (18% versus 6% at 3 months; v2 = 27.597, p \ 0.0001; 23% versus 12% at 6 months; v2 = 18.0, p \ 0.0001), with scheduling
Ó Society of Surgical Oncology 2020 First Received: 15 April 2020 Accepted: 27 June 2020 N. Ahmadiyeh, MD, PhD e-mail: [email protected]
component driving effectiveness. Of those who were successfully contacted, uptake was significantly greater among those who scheduled appointments versus those who did not (47% versus 9%, v2 = 95, p \ 0.0001), and uptake was no different between contacted but not scheduled patients and usual care controls. Conclusions. Phone call with access-enhancing intervention (facilitating mammogram appointments) increased screening mammogram uptake among primary care patients in an urban safety-net setting and may be applicable to other urban SNHs around the country.
Early detection of breast cancer results in diagnosis at earlier stages, less aggressive treatments, and improved survival.2–6 Despite being Commission on Cancer (CoC) accredited with commendation—a designation that suggests our facilities provide the highest standard of cancer care—our urban safety-net hospital (SNH) still sees nearly thr
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