This community study will assess the impact of an urban outreach series of interventions on the rates of screening mammography for women 65 years of age and over. The three populations targeted for interventions are: 1) primary care physicians who refer patients for mammography; 2) all women 65+ and 3) community radiologists. The primary intervention is a 1-on-1 practice based educational session with physicians that will include the recent California law's coverage of screening mammography; issues related to breast cancer and aging, such as the decreasing utilization of mammography with increasing age; racial discrepancies, such as Black and Hispanic women over age 65 having had far less mammography experience than White women; the older women's general high acceptance of mammography; and the UCLA outreach program in the community to reach women 65+ about these issues. Specially designed educational materials will be provided to these physicians. If the Medicare benefit become effective in January 1991, the new information will be promoted to physicians through hospital CME programs. This intervention will be given to all referring physicians in two experimental communities. The practices in the matched community will serve as the comparison group. The second intervention will increase the awareness of women 65+ in the experimental communities about the California law, increase women's requests to referring physicians for a screening mammogram, and inform and promote mammography through the outreach program with strategies previously determined to be effective with older women of different races. The tertiary intervention will target all radiologists who perform mammography in the experimental communities to continue to contain or reduce costs, and will ensure that all facilities are prepared to process Medicare billings for screening mammograms properly should the coverage become effective in January 1991. Analyses of the proposed interventions will rely on a quasi-experimental design that includes experimental and matched comparison communities for assessing the interventions with physicians, women, and radiologists. The overall goal of this project is to improve mammogram utilization rates in 65+ women by at least 10% over the secular trend determined by the 1990 and 1991 surveys of women 65+. This proposal is requesting the year 2 funds of a 2 year supplement that has been funded and ongoing since October 1989.
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