Using Self-Scheduling to Improve Screening Mammography Completion Rates

Abstract

Purpose: Self-scheduling has the potential to enhance convenience and patient engagement. We compared outpatient screening mammography completion rates before and after implementing an online self-scheduling system between patients who use self-scheduling versus traditional scheduling.

Methods: In February 2021, a self-scheduling process was implemented at an institutional level through the Epic MyChart online portal, allowing patients to self-schedule screening mammography. This retrospective cohort study included women aged 18 and over who scheduled outpatient screening mammography in a tertiary health care facility from October 1, 2017, to June 30, 2023, had at least one encounter during the pre-implementation phase and one encounter during the postimplementation period, and only used one scheduling method (self-scheduling or traditional scheduling) in the postimplementation period. Difference-in-difference analyses were conducted to compare screening mammography completion rates between patients who used traditional versus self-scheduling in the postimplementation period.

Results: In all, 29,893 screening mammography were scheduled by 7,203 patients (mean age: 58.1 years; 70.0% White, 18.2% Asian, 1.8% Black, and 19.5% Hispanic). The overall mammography completion rate in pre-implementation period was 78.9% and increased to 79.8% in the postimplementation period. Using difference-in-difference estimator, the completion rates in the self-scheduling cohort was 8.4 percentage point (95% confidence interval, 5.2-11.6) higher than traditional scheduling. The change in screening mammography completion rate from the postimplementation to pre-implementation period was +8.5 percentage point (88.1% postimplementation versus 79.6% pre-implementation) for the self-scheduling cohort and +0.1 percentage point (80.8% postimplementation versus 80.7% pre-implementation) for the traditional scheduling cohort.

Conclusion: Self-scheduling was linked to increased screening mammography completion rates postimplementation when compared to traditional scheduling.

Keywords: Completion; health disparity; screening mammography; self-schedule.

Fig. 1.

Adjusted screening mammography (SM) completion rate based on implementation time among patients with at least one encounter in pre- and postimplementation period. Self-scheduling cohort: Those who only used self-scheduling after implementation (n = 628 patients). Traditional scheduling cohort: Those who only used traditional scheduling after implementation (n = 6,575 patients).

Fig. 2.

Difference-in-difference estimates and their 95% confidence intervals for screening mammography completion rates between self-scheduling (those who only used self-scheduling after implementation; n = 628 patients) and traditional scheduling (those who only used traditional scheduling after implementation; n = 6,575 patients) cohorts for selected characteristic variables. ADI NATRANK = area deprivation index national rank; lowest ADI = least disadvantaged neighborhoods.