Communication Practices of Mammography Facilities and Timely Follow-up of a Screening Mammogram with a BI-RADS 0 Assessment

Abstract

Rationale and objectives: The objective of this study was to evaluate the association of communication practices with timely follow-up of screening mammograms read as Breast Imaging Reporting and Data Systems (BI-RADS) 0 in the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium.

Materials and methods: A radiology facility survey was conducted in 2015 with responses linked to screening mammograms obtained in 2011-2014. We considered timely follow-up to be within 15 days of the screening mammogram. Generalized estimating equation models were used to evaluate the association between modes of communication with patients and providers and timely follow-up, adjusting for PROSPR site, patient age, and race and ethnicity.

Results: The analysis included 34,680 mammography examinations with a BI-RADS 0 assessment among 28 facilities. Across facilities, 85.6% of examinations had a follow-up within 15 days. Patients in a facility where routine practice was to contact the patient by phone if follow-up imaging was recommended were more likely to have timely follow-up (odds ratio [OR] 4.63, 95% confidence interval [CI] 2.76-7.76), whereas standard use of mail was associated with reduced timely follow-up (OR 0.47, 95% CI 0.30-0.75). Facilities that had standard use of electronic medical records to report the need for follow-up imaging to a provider had less timely follow-up (OR 0.56, 95% CI 0.35-0.90). Facilities that routinely contacted patients by mail if they missed a follow-up imaging visit were more likely to have timely follow-up (OR 1.65, 95% CI 1.02-2.69).

Conclusions: Our findings support the value of telephone communication to patients in relation to timely follow-up. Future research is needed to evaluate the role of communication in completing the breast cancer screening episode.

Keywords: Screening mammography; communication; timely follow-up.

Figure 1.

Percentage with timely follow-up of a screening BI-RADS 0 by patient contact modality. The percentage of patients with timely follow-up within 0–15 days is shown after a screening mammogram assessed an incomplete BI-RADS 0 ordered by the number of screening mammograms with a BI-RADS 0 in the data collection period. Timely follow-up is divided into those followed up on the same day as the screening mammogram vs 1–15 days after the initial screening mammogram. The x−axis presents the 28 facilities ordered from those with the lowest to those with the highest number of mammography screening examinations in the study. BI-RADS, Breast Imaging Reporting and Data Systems.

Figure 2.

(a) Percentage with timely follow-up within days 1–15 by patient contact modality. The percentage of patients with timely follow-up within 1–15 days is shown after a screening mammogram assessed an incomplete BI-RADS 0 by facility type of communication with the patient. Facilities are classified by mail or phone communication to illustrate findings of the multivariate model. Additional methods (patient portal, in person) may also have been used. One facility using neither mail nor phone is not depicted. The number of facilities using that combination of mail or phone communication modality is given in parentheses. (b) Percentage with timely follow-up within days 1–15 by provider contact modality. The percentage of patients with timely follow-up within 1–15 days is shown after a screening mammogram assessed an incomplete BI-RADS 0 by facility type of communication with the health-care provider. Facilities are classified by fax only, electronic medical record only, or electronic medical record + fax or mail to further illustrate findings of the multivariate model. One facility using phone only and one facility reporting no routine communication with the provider in this scenario are not depicted. The number of facilities using that provider mode of communication is given in parentheses. BI-RADS, Breast Imaging Reporting and Data Systems.