Background Despite trials of mammography and widespread use, optimal screening policy is controversial. Design and Objective Six models use common data elements to evaluate US screening strategies. Data Sources The models use national data on age-specific incidence, competing mortality, mammography characteristics and treatment effects. Target Population and Time Horizon A contemporary population cohort followed over their lifetimes. Perspective We use a societal perspective for analysis. Interventions We evaluate 20 screening strategies with varying initiation and cessation ages applied annually or biennially. Outcome Measures Number of mammograms, breast cancer mortality reduction or life years gained [LYG] (vs. no screening), false positives, unnecessary biopsies and over-diagnosis. Results of Base Case The 6 models produce consistent rankings of screening strategies. Screening biennially maintains an average of 81% (range across strategies and models 67–99%) of the benefit of annual screening with almost half the number of false positives. Screening biennially from ages 50 to 69 achieves a median 16.5% (range 15%–23%) breast cancer mortality reduction vs. no screening. Initiating biennial screening at age 40 (vs. 50) reduces mortality by an additional 3% (range 1%–6%), consumes more resources and yields more false positives. Biennial screening after age 69 yields some additional mortality reduction in all models but over-diagnosis increases most substantially at older ages. Sensitivity Analysis Results Varying test sensitivity or treatment patterns do not change conclusions. Limitations Results do not include morbidity from false positives, knowledge of earlier diagnosis or under-going unnecessary treatment. Conclusion Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms and resource considerations.

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Background and Objectives Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons’ transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living. Research Design and Methods Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC. Only English articles were reviewed. Based on the Meleis’ Health Transition (MHT) model, we categorized findings into: (a) transition conditions; (b) patterns of response; and (c) health services and interventions. Results We included 204 unique studies. Age, cognitive/functional impairments, and caregiver burden were the most consistent risk factors for older persons’ transitions to FBC. Caregiver burden was the only consistent risk factor in both quantitative and qualitative literature. Other factors around health service use or nonmedical factors were examined in a small number of studies, or demonstrated mixed or nonsignificant results. Key research gaps relate to transitions to intermediate levels of FBC, research in public health systems, and research employing qualitative and interventional methods. Discussion and Implications We expanded the MHT model to capture informal caregivers and their critical role in transitions from home to FBC settings. More research is needed to address practical needs of clients and caregivers while at home, and self-directed care funding models could be expanded. Theory-driven interventional research focusing on caregivers and successful hospital discharge is critically needed.