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. 2022 Apr;25(2):244-253.
doi: 10.1089/pop.2021.0382.

Closing the Gap: A Comparison of Engagement Interventions to Achieve Equitable Breast Cancer Screening in Rural Illinois

Sarah Stewart de Ramirez  1   2 , Jeremy McGarvey  3 , Abby Lotz  4   5 , Mackenzie McGee  6 , Tenille Oderwald  7 , Katherine Floess  2 , Roopa Foulger  3   5 , Melinda Cooling  5 , Jonathan A Handler  8   9
Affiliations

Closing the Gap: A Comparison of Engagement Interventions to Achieve Equitable Breast Cancer Screening in Rural Illinois

Sarah Stewart de Ramirez et al. Popul Health Manag. 2022 Apr.

Abstract

Mammography screening rates are typically lower in those with less economic advantage (EA). This study, conducted at an integrated health care system covering a mixed rurality population, assessed the ability of interventions (text messages linking to a Web microsite, digital health care workers, and a community health fair) to affect mammography screening rates and disparity in those rates among different EA populations. Payor type served as a proxy for greater (commercially insured) versus lower (Medicaid insured) EA. 4,342 subjects were included across the preintervention ("Pre") and postintervention ("Post") periods. Interventions were prospectively applied to all Medicaid subjects and randomly selected commercial subjects. Applying interventions only to lower EA subjects reversed the screening rate disparity (2.6% Pre vs. -3.7% Post, odds ratio [OR] 2.4 P < 0.01). When intervention arms ("Least," "More," "Most") were equally applied, screening rates in both EA groups significantly increased in the More arm (Medicaid OR = 2.04 P = 0.04, Commercial OR = 3.08 P < 0.01) and Most arm (Medicaid OR 2.57 P < 0.01, Commercial OR 2.33 P < 0.01), but not in the Least (text-only) arm (Medicaid OR 1.83 P = 0.11, Commercial OR 1.72 P = 0.09), although this text-only arm was inadequately powered to detect a difference. In summary, targeting interventions to those with lower EA reversed screening rate disparities, text messaging combined with other interventions improved screening rates in both groups, and future research is needed to determine whether interventions can simultaneously improve screening rates for all without worsening the disparity.

Keywords: breast cancer; digital health; health disparities; patient engagement; population health.

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Conflict of interest statement

Dr. Handler is the President of Keylog Solutions LLC, a health care software and health care consulting company. He holds equity in EmOpti, LLC, a health care software company. He holds equity in and consults for Whispersom Corporation, a medical device company. He owns shares in Baxter Healthcare, a publicly traded medical device and pharma company. The remaining authors have nothing to declare.

Figures

FIG. 1.
FIG. 1.
Mammography rates in commercially insured compared with Medicaid-insured patients, before and after interventions, were applied to the Medicaid-insured patients. Rates adjusted for age, race/ethnicity, and primary language.
FIG. 2.
FIG. 2.
Mammography rates and disparity between commercially insured and Medicaid-insured patients by intervention and time frame.
See this image and copyright information in PMC

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