Improving mammography through effective screening, brief intervention, and referral to treatment at a rural health center

Abstract

Background: Screening mammography rates at a rural health center were below state rates, while the countywide rate of breast cancer was above the state and national rates.

Local problem: Only 25% of patients at the practice site received a screening mammogram within the last 2 years, and standing order usage was 25%. Evidence-based guidelines and decision aids were not used consistently. The aim was to increase the rate of screening mammograms and right care at a rural health center to 55% of eligible patients in 90 days.

Methods: Implementation consisted of four 2-week plan, do, study, act cycles. Interventions included screening, brief intervention with patient engagement, referral to treatment with case management log tracking, and team engagement. Aggregate data were collected twice weekly.

Intervention: An electronic health record reminder for mammography screening, a patient mammography decision aid, a case management log, and weekly quality improvement team meetings were the four core interventions used for the project.

Results: Screening and identification improved by 40%, patient engagement improved by 30%, and case management for right care more than doubled. Overall, the combined mammography and right care rate improved by 40%. Team engagement reached 100% with survey scores for involvement rising to 78%.

Conclusions: The results obtained indicate the tools and processes implemented effectively increased screening, patient engagement, and case management to improve mammography rates and right care.