Substantial evidence supports the effectiveness of screening mammography in reducing breast cancer mortality and the effectiveness of mailed and telephone reminders and counseling in increasing timely screening. Widespread adoption of mammography reminder and counseling systems (MRCS) designed to reach and meet the needs of the older women, minority women has the potential to decrease breast cancer mortality nationwide. However, MRCS adoption faces many barriers including uncertainty about the roles of primary care practices, managed care organizations, and integrated healthcare networks (IHN), fragmentation of information systems, and absence of model system components ready for implementation. In many areas, IHNs are in an ideal position to adopt MRCSs because of their connections to primary care (PCP) and mammography providers, and their access to information systems. We propose to 1) demonstrate the feasibility and effectiveness of implementing and institutionalizing a comprehensive MRCS within a large, IHN and at 2) document the barriers we encounter along with strategies for overcoming them. The system would use aggregated MCO claims data and IHN clinical scheduling and mammography data systems to track mammography use among women >=40 years who are patients of PCPs affiliated with the IHN. Women deemed eligible by their PCPs and overdue for a mammogram would be mailed tailored reminders in the patient's preferred language, and a second reminder if necessary. Nonresponders would get a telephone call that includes a verbal reminder and an offer to schedule a mammogram. Counseling would be provided for those hesitant to schedule. Building on 10 year's experience in developing and evaluating MRCSs and on the educational materials and computer-assisted telephone counseling protocols we have developed, we propose to implement a model MRCS in the IHN. Following implementation we would engage key stakeholders within and outside the IHN in a process aimed at institutionalizing the MRCS. We would evaluate system reach for targeted women and practices, effectiveness in increasing timely mammography, acceptance of the system by the PCPs and women, and fidelity of intervention delivery. We would prepare an implementation manual and a package of print materials and software to facilitate dissemination of the effective components of the MRCS model. 7. Project Narrative Research has shown that mailing reminders and calling women who are due or overdue for a screening mammogram can increase the chances that these women will get a mammogram. The goal of this project is to study the implementation of a program in a large healthcare network that systematically provides mailed reminders and calls to women age 40 and older who are patients of primary care providers in the network and are due or overdue for a mammogram. We will also work with the leaders of the healthcare network and health insurance plans to make the program a permanent service provided by the network.
| Luckmann, Roger; White, Mary Jo; Costanza, Mary E et al. (2017) Implementation and process evaluation of three interventions to promote screening mammograms delivered for 4 years in a large primary care population. Transl Behav Med 7:547-556 |
