Despite the proven value of mammography, its efficacy depends in large part on radiologists' interpretations and radiologists differ substantially in their interpretations. HYPOTHESES: Community mammography performance can be enhanced by better understanding sources of variability among radiologists and by working directly with radiologists in improving evaluation of their individual performance.
SPECIFIC AIMS : 1.) To use statistical methods to estimate the accuracy of mammography at the level of individual radiologists and better understand reasons for variability. 2.) To better understand radiologist level characteristics associated with interpretive performance. 3.) To evaluate the feasibility and impact of an interactive web-based educational intervention and new audit reporting system. STUDY DESIGN: This cohort study will be organized within a conceptual framework previously proven to result in both physician behavior change and improved patient outcomes. Hierarchical statistical models will be developed using Breast Cancer Surveillance Consortium data from four population-based mammography registries in New Hampshire, Colorado, North Carolina, and Washington (Aim 1). Data from these Surveillance registries are available on more than two million mammography encounters. A survey, which will augment existing Surveillance data, will be sent to 400 radiologists to determine if radiologists understand concepts of numeracy (rates, risks and probability) in general and specifically related to breast cancer screening (Aim 2). Survey data will be linked with Surveillance data at an individual radiologist level. Information learned from Aims 1 and 2 will guide development and testing of an interactive web-based educational tool designed to improve radiologists' understanding of their own interpretive performance and to enhance use of audit reporting systems (Aim 3).

Public Health Relevance

Mandatory 'skills testing' is being considered in Congressional hearings as the Mammography Quality Standards Act is reviewed. Current methods of assessing the accuracy of individual radiologists are inadequate and there is no data to show that individual skills testing will improve accuracy of radiologists. This work builds on our previous model development and is a natural extension in a timely and important clinical area. ? ?

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Health Services Organization and Delivery Study Section (HSOD)
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Taplin, Stephen
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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Elmore, Joann G; Cook, Andrea J; Bogart, Andy et al. (2016) Radiologists' interpretive skills in screening vs. diagnostic mammography: are they related? Clin Imaging 40:1096-1103
Lott, Jason P; Piepkorn, Michael W; Elmore, Joann G (2015) Dermatology in an age of fully transparent electronic medical records. JAMA Dermatol 151:477-8
Jackson, Sara L; Abraham, Linn; Miglioretti, Diana L et al. (2015) Patient and Radiologist Characteristics Associated With Accuracy of Two Types of Diagnostic Mammograms. AJR Am J Roentgenol 205:456-63
Buist, Diana S M; Anderson, Melissa L; Smith, Robert A et al. (2014) Effect of radiologists' diagnostic work-up volume on interpretive performance. Radiology 273:351-64
Geller, Berta M; Bogart, Andy; Carney, Patricia A et al. (2014) Educational interventions to improve screening mammography interpretation: a randomized controlled trial. AJR Am J Roentgenol 202:W586-96
Carney, Patricia A; Bogart, Andy; Sickles, Edward A et al. (2013) Feasibility and acceptability of conducting a randomized clinical trial designed to improve interpretation of screening mammography. Acad Radiol 20:1389-98
Carney, Patricia A; Abraham, Linn; Cook, Andrea et al. (2012) Impact of an educational intervention designed to reduce unnecessary recall during screening mammography. Acad Radiol 19:1114-20
Carney, Patricia A; Cook, Andrea J; Miglioretti, Diana L et al. (2012) Use of clinical history affects accuracy of interpretive performance of screening mammography. J Clin Epidemiol 65:219-30
Haneuse, Sebastien; Buist, Diana S M; Miglioretti, Diana L et al. (2012) Mammographic interpretive volume and diagnostic mammogram interpretation performance in community practice. Radiology 262:69-79
Jackson, Sara L; Cook, Andrea J; Miglioretti, Diana L et al. (2012) Are radiologists' goals for mammography accuracy consistent with published recommendations? Acad Radiol 19:289-95

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