Abstract
Breast cancer is the most common non–skin cancer among women, and risk increases with age. 1 Most major agencies recommend routine mammography from ages 50 to 75 years old because the benefits of screening outweigh the harms of increased testing and treatment.1,2 Nationally, 68% of eligible women with health insurance have undergone mammography within the last 2 years. 3 Initial data in 2016 showed that East Carolina Adult and Pediatric Health Care was well behind the national average with only 48% of eligible women screened. The aim was to increase that proportion to 80% by May 2019.
A brainstorming session was held and a process flow-chart was developed at the beginning of the project. Based on the experience of staff and literature from similar environments, 4 barriers to screening were identified: awareness of the need, knowledge regarding recommended age and frequency of screening, availability of places to perform mammograms, and cost. Several interventions were implemented throughout the 3 years of this project. The change that made the most impact was distributing information sheets when women in the target age range checked in to the clinic. These sheets included information regarding the importance of mammograms and radiology practices in town offering free screening mammograms without appointments. To reach women who did not have appointments during the initial intervention period, this information was sent to all eligible women via the electronic messaging system embedded in the electronic health record. During this time, an effort was underway in the physician group to increase sign-up for electronic messaging. After adoption of this system increased, another electronic message was sent to all eligible women. This intervention correlated with a 10% increase in mammogram rates, whereas the first electronic message correlated with a decrease of 8%.
Although the target of 80% was not achieved, 72% of eligible women in the target population were up-to-date on screening mammograms as of May 2019, an increase of 24%. There was a correlated increase in rates after the intervention of information sheets that addressed patient barriers to care, such as patient awareness, cost, and how to undergo screening. Incorporation of reminders into the workflow increases the likelihood that the improvement can be sustained.