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Waddell KJ, Goel K, Park SH, Linn KA, Navathe AS, Liao JM, McDonald C, Reitz C, Moore J, Hyland S, Mehta SJ. Association of Electronic Self-Scheduling and Screening Mammogram Completion. Am J Prev Med 2024; 66:399-407. [PMID: 38085196 PMCID: PMC10922640 DOI: 10.1016/j.amepre.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION The purpose of this study was to evaluate if an electronic health record (EHR) self-scheduling function was associated with changes in mammogram completion for primary care patients who were eligible for a screening mammogram using U.S. Preventive Service Task Force recommendations. METHODS This was a retrospective cohort study (September 1, 2014-August 31, 2019, analyses completed in 2022) using a difference-in-differences design to examine mammogram completion before versus after the implementation of self-scheduling. The difference-in-differences estimate was the interaction between time (pre-versus post-implementation) and group (active EHR patient portal versus inactive EHR patient portal). The primary outcome was mammogram completion among all eligible patients, with completion defined as receiving a mammogram within 6 months post-visit. The secondary outcome was mammogram completion among patients who received a clinician order during their visit. RESULTS The primary analysis included 35,257 patient visits. The overall mammogram completion rate in the pre-period was 22.2% and 49.7% in the post-period. EHR self-scheduling was significantly associated with increased mammogram completion among those with an active EHR portal, relative to patients with an inactive portal (adjusted difference 13.2 percentage points [95% CI 10.6-15.8]). For patients who received a clinician mammogram order at their eligible visit, self-scheduling was significantly associated with increased mammogram completion among patients with an active EHR portal account (adjusted difference 14.7 percentage points, [95% CI 10.9-18.5]). CONCLUSIONS EHR-based self-scheduling was associated with a significant increase in mammogram completion among primary care patients. Self-scheduling can be a low-cost, scalable function for increasing preventive cancer screenings.
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Affiliation(s)
- Kimberly J Waddell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Cresencz VA Medical Center, Philadelphia, PA.
| | - Keshav Goel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sae-Hwan Park
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Kristin A Linn
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Amol S Navathe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Cresencz VA Medical Center, Philadelphia, PA
| | - Joshua M Liao
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Medicine, University of Washington, Seattle, WA
| | - Caitlin McDonald
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, PA
| | - Catherine Reitz
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, PA
| | - Jake Moore
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steve Hyland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shivan J Mehta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, PA
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Abou Leila RM, Shannon M, El-Nigoumi SEN. Improving physician compliance with mammography screening by implementing a breast cancer screening guideline at a hospital in Bahrain. BMJ Open Qual 2021; 10:bmjoq-2021-001351. [PMID: 34433579 PMCID: PMC8388283 DOI: 10.1136/bmjoq-2021-001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background From a health and safety perspective, it is critical to use adequate, evidence-based breast screening guidelines. The aim of this quality improvement project was to improve physicians’ compliance with breast cancer screening guidelines to enhance the mammography screening rate among eligible women; this was achieved through the implementation of multifaceted changes to the hospital’s processes and the improvement of physicians’ attitudes towards the guidelines. Methods The project used the Plan-Do-Study-Act method to implement the changes. This was a pre-post evaluation study. The data were collected from patients’ charts. The primary outcome of interest was the rate of physician compliance with mammography screening guidelines before and after the implementation of the process changes. A literature review was conducted to determine which women should be identified as eligible for mammography screening. Intervention The interventions targeted physician knowledge and hospital processes. Improving doctors’ expertise was achieved by implementing the US Preventive Service Task Force recommendation for mammography screening every 2 years for women aged 50–74 years. The process modifications included the establishment of a system that would be effective in identifying at-risk patients and reminding physicians at the point of care. Results Over the course of this study, 825 patients met the criteria for breast cancer screening. The rate of physician compliance with the breast cancer screening guideline increased from 2% to 69% after 23 weeks, and the control charts demonstrated a reliable process. Conclusion This project examined the relationship between different interventions (identification of the eligible patient, reminder alerts and physician knowledge) and physician compliance with mammography screening guidelines. The results suggest a positive link between the study variables and physicians’ compliance with mammography screening guidelines.
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Affiliation(s)
| | - Michael Shannon
- Healthcare Leadership, Global Leadership Consultancy, Drumcliff, Ireland
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McDermott AK, McDermott AJ, Osbaldiston R, Lennon RP. Improving Breast and Cervical Cancer Screening Compliance Through Direct Physician Contact in a Military Treatment Facility: A Non-randomized Pilot Study. Mil Med 2021; 186:e480-e485. [PMID: 33175964 DOI: 10.1093/milmed/usaa436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/19/2020] [Accepted: 10/08/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Screening for breast cancer (BC) and cervical cancer (CC) decreases morbidity and mortality. Most interventions to improve screening rely on automated modalities or nonphysician patient contact. There is limited data on direct patient contact by a physician to encourage BC and CC screening. This non-randomized pilot study sought to evaluate the potential of direct physician contact to improve BC and CC screening rates. MATERIALS AND METHODS A Family Medicine physician telephoned patients on his panel who were due or overdue for BC and CC screening. If the patient did not answer her phone, a voicemail was left; if unable to leave a voicemail, a letter was mailed. The completion rate of recommended screening tests was measured 3 months after contact and compared to a retrospectively identified control population. The change in compliance of the patient panel over 3 months was also calculated. RESULTS Direct physician conversation by telephone yielded higher completion rates for BC and CC screening versus control patients, but only the CC completion rate increase was statistically significant. Direct conversation BC screening completion rate: 41.2% versus 22.7% (P = .22, n = 48). Direct conversation CC screening completion rate: 45% versus 13.9% (P = .01, n = 44). The intervention patient panel compliance with screening recommendations increased 20.5% for BC and 10.5% for CC. CONCLUSION Direct physician contact may be beneficial to increase compliance for more invasive screening tests.
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Affiliation(s)
- Alexis K McDermott
- Directorate for Nursing Services, Naval Hospital Rota, 11520 Cádiz, Spain
| | | | - Richard Osbaldiston
- Department of Psychology, Eastern Kentucky University, Richmond, Kentucky, KY 40475, USA
| | - Robert P Lennon
- Penn State College of Medicine, Department of Family and Community Medicine, Hershey, PA 17033, USA
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