This community-wide study will design, implement and evaluate interventions aimed at increasing the rates of quality-controlled mammography and breast physical examinations for women 50 years of age and over. The three populations targeted for interventions are: 1) physicians who refer patients for mammography -- family physicians, gynecologists; internists; and the nurse practitioner or head nurse in their practice; 2) radiologists who perform mammography; and 3) all women 50 years old and over. The primary intervention is a practice-based CME program for one-half of the randomly chosen practices in Family Medicine, Internal Medicine and Gynecology. The other practices in each specialty will serve as the control group. The intervention group will also be trained in the use of chart reminders which serve as a behavioral cue when used in the medical chart in their clinical practice. Secondary interventions will target: 1) radiologists and technologists who are targeted for improvement in the usage of equipment and for better patient access through cost reduction; and 2) patients over age 50, who are targeted to increase their awareness and knowledge of mammography and to increase their requests to primary care physicians for the clinical breast exam and screening mammograms. Analyses of the proposed interventions will rely on a randomized two-group design for evaluating the physician intervention, a quasi-experimental approach for evaluating the community-based cancer control education program, and a pre- and post-test design for assessing the intervention for radiologists. The overall goal of this project is to improve the rates of referral for mammography in the over age 50 women in the selected communities by at least 100% from the levels identified in the baseline year. We propose also to significantly increase the numbers of breast physical exams for this age group.
Showing the most recent 10 out of 17 publications
