The Use of Reminders to Improve Mammogram Screening Rates in a Medicine Resident Ambulatory Clinic

Jennifer Kim, MD Department of Internal Medicine, Banner Good Samaritan Internal Medicine Center

AIM Statement

The use of reminders to eligible patients in the Resident Clinic to have a mammogram will improve rates of screening. Over a 6 month period, compliance with screening in women > 50 will improve from 37% to 50%.

Background

Breast cancer is the second leading cause of cancer related deaths in women. Screening with mammography has been shown to decrease mortality from breast cancer. To increase breast cancer screening rates, several interventions have focused on increasing the rate at which physicians offer mammography. These interventions have targeted various types of reminders including phone calls and letters. One study showed a 15.3% increase in adherence to mammograms when patients were contacted through calls and reminders. Other studies found that a recommendation by a physician is a strong determinant of whether a woman receives a mammogram.

Purpose

To increase the percentage of mammogram screenings in women for whom screening is recommended in an internal medicine residency ambulatory clinic.

Conclusions and Next Steps:

A multi-reminder program that incorporated automated telephone calls improved mammography screening by at least 15%.

These findings may suggest that the use of reminders may increase mammography screening rates in similar clinic settings.

What You Learned: Residents in an Internal Medicine Residency clinic can improve patient care through the implementation of basic quality improvement principles.

Despite improvements, we are still not at goal screening rates and will need to explore additional ideas and continue to refine our interventiion to make the results last.

Methods:

There was a two phase QI project- phase 1 was June-July 2012, and phase 2 was January-February 2013. In phase one of this project a protocol was constructed and implemented for which all the residents in ambulatory clinic were to follow an audit tool (Figure 1) to see if the female patients in their panel had up-to-date mammogram screenings. They were to contact their patients about mammography screening and write the names of the females >50 year old contacted onto a worksheet along with the date of previous mammograms.In Phases one and two, patients were reminded through phone calls and reminders to get their mammograms.

Results:

At the beginning of the study, there were 93 of 250 = 37.2% female patients over age 50 that were up to date on their mammograms.

After the intervention, there were 179 of 340 = 52.6% female patients up to date on their mammograms after reminder calls/ letters. This difference in compliance rates was significant. (Table 1)

Project Status:

It was completed, and submitted to Academic Excellence Day. It was accepted as a poster and displayed at that conference.

Phase 1 Phase 2 p

% up to datemammogram

66/176(37.5%)

120/211(56.9%) < 0.001

Phase 1 Phase 2 p

% up to datemammogram

93/250(37.2%)

179/340(52.6%) < 0.001

Barriers /Setbacks:

We only had one “pre” period. It would have been beneficial to have multiple “pre” periods to know if the intervention affected the trend in previous rates.

• Since some residents were included in phase 1 data only, and some included in phase 2 data only (due to clinic schedules), a separate analysis was done comparing rates between phase 1 and phase 2 only for residents who had clinic patients during both phases. These two proportions (37.5% in phase 1 and 56.9% in phase 2) were also significantly different from each other (Table 2)

Table 1 : Analysis of all residents

Table 2: Analysis of residents participating in both phases