Medical home transformation and breast cancer screening

Abstract

Objectives: The patient-centered medical home (PCMH) continues to gain momentum as a primary care delivery system. We evaluated whether medical home transformation of primary care practices is associated with the use of breast cancer screening, a broadly endorsed preventive service.

Study design: Retrospective cohort study evaluating 12 Brigham and Women's Hospital (BWH)-affiliated primary care clinics in greater Boston, Massachusetts.

Methods: Practice transformation was measured quarterly using a continuous PCMH transformation score (range = 0-100) modeled after National Committee for Quality Assurance recognition requirements. We included women aged 50 to 74 years who had at least 1 primary care visit at a participating clinic between April 2012 and December 2013 (n = 20,349)-a period of medical home transformation. The main measures included: a) whether screening was up-to-date at the time of the visit (mammography completion within 24 months prior to the visit); and b) if screening was overdue at the visit (ie, it had been more than 24 months since the last mammogram), and whether timely screening was completed within 3 months after the visit.

Results: In adjusted analyses, PCMH transformation scores were negatively associated with up-to-date screening status (odds ratio [OR] for a 20-point change, 0.93; 95% confidence interval [CI], 0.89-0.96) and with timely screening of women who were overdue (OR, 0.94; 95% CI, 0.87-1.02).

Conclusions: Preventative care, such as breast cancer screening, may not improve in early PCMH implementation.

Figure 1

Flow diagram of primary care visits and screening status. Note: 20,349 women had at least one primary care visit during the study period. Screening was considered up-to-date if mammography was completed within preceding 24 months of visit. Screening was overdue if there was no mammography in preceding 24 months. Screening was considered timely if completed within 3 months of visit if overdue at the time of the visit.