Quality assurance audits of community screening mammography practices: availability of active follow-up for data collection and outcome assessment

Abstract

Objective: Routine and periodic mammography audit studies, the systematic evaluation of clinical follow-up procedures and outcomes subsequent to screening mammography reports of abnormal findings, have been advocated as an important component of quality assurance in screening mammography. This study assessed the degree to which mammography facilities in community practice maintain reporting and record-keeping systems and ascertain sufficient clinical follow-up data to facilitate the practice of mammography audit studies.

Materials and methods: As part of a national survey of 1057 mammography facilities, data were collected from a stratified subsample of 50 facilities on facility information systems, and facility records were systematically abstracted to determine the degree of completeness of clinical follow-up data to screening mammography examinations with abnormal findings. Facilities were assisted in obtaining additional information through active data follow-up, and this information also was entered into the study's database.

Results: The nature of mammography information systems and the degree of data completeness varied widely. Computerized systems were used at relatively few facilities (12%). The organization of records and data varied widely and was generally not designed to accommodate routine systematic analysis. Screening examinations could be identified without reading the actual text of the mammography report at 94% of the facilities, but reports had to be read at the majority of facilities to identify examinations with abnormal findings (70%). Before active data follow-up, records were incomplete in about 40% of all cases. After active data follow-up, this decreased to 16%. Forty-two facilities achieved an average completeness of more than 90%, whereas the remaining eight lagged significantly behind this level.

Conclusion: At the time of this study (late 1992 to early 1993), only about 20% of the facilities surveyed had informational systems and sufficient ascertainment of data to support the practice of mammography audit studies. After active data follow-up, more than 80% of the facilities were willing and able to achieve a high degree of data completeness with the assistance of our data abstracters. The results of this study suggest that, with the advent of standardized mammography data collection and analysis systems and increased emphasis on clinical outcomes assessment as a standard of care, the practice of performing mammography audits, although not currently widespread, is feasible for most facilities.