Effects of program scale-up on time to resolution for patients with abnormal screening mammography results

Lee, Simon J. Craddock; Higashi, Robin T.; Sanders, Joanne M.; Zhu, Hong; Inrig, Stephen; Mejias, Caroline; Argenbright, Keith; Tiro, Jasmin A.

doi:10.1007/s10552-018-1074-4

Cited by 3 publications

(6 citation statements)

References 43 publications

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“…In our study, over 90% of patients achieved diagnostic resolution with median time to resolution of 27 days. This finding is consistent with prior studies in minority patients have cited follow‐up rates in similar ranges . We also found that, consistent with prior literature, 90% of patients who achieved diagnostic resolution do so within 60 days .…”

Section: Discussionsupporting

confidence: 93%

“…[16][17][18][19] We also found that, consistent with prior literature, 90% of patients who achieved diagnostic resolution do so within 60 days. 16 The landmark of 60 days has been established through quality measures by the National Breast and Cervical Cancer Early Detection Program, a program sponsored by the Centers for Disease Control & Prevention that provides screening services to underserved woman. 19 Yet, while most patients achieved diagnostic resolution within 60 days, biopsies on average took place >30 days after an uncertain screening mammogram, which is longer than previously published data.…”

Section: Discussionsupporting

confidence: 90%

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Time to diagnostic resolution after an uncertain screening mammogram in an underserved population

et al. 2020

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Background: Screening mammography has reduced breast cancer-associated mortality worldwide. Approximately 10% of patients require further diagnostic testing after an uncertain screening mammogram (Breast imaging reporting and data system [BI-RADS] = 0), and time to diagnostic resolution varies after BI-RADS = 0 screening mammogram. There is little data about factors associated with diagnostic resolution in patients of Chinese origin ("Chinese") receiving care in the US. Methods: We performed a retrospective analysis to identify patterns of diagnostic resolution in an urban US hospital with a large population of Chinese patients. We evaluated whether location of primary care provider (PCP) impacted time to resolution among Chinese patients, hypothesizing that patients with a PCP outside of the hospital would have longer time to diagnostic resolution than those patients with a PCP within the institution. Results: Between 2015 and 2016, 368 patients at Tufts Medical Center (Tufts MC) had resulting BI-RADS = 0 after screening mammogram. The majority of patients (341/368, 93%) achieved diagnostic resolution with median time to resolution 27 days (Q1: 14, Q3: 40). Seven percent (27/368) never achieved resolution. Among those with diagnostic resolution, 10% of patients required >60 days to achieve resolution. Chinese origin, no previous breast cancer, subsidized insurance, and outside referring physician were associated with longer time to resolution in univariable analysis. In multivariable regression, after adjusting for age, insurance, marital status, and prior breast cancer, Chinese patients with Tufts MC PCP experienced timelier diagnostic resolution vs Chinese patients without a Tufts MC PCP (hazard ratio [HR] = 1.85, P = .02). Location of PCP did not impact time to resolution among non-Chinese patients. Conclusion: We identified patterns of diagnostic resolution in an urban hospital with a large historically underserved population. We found that Chinese patients without integrated primary care within the institution are at risk for delayed diagnostic resolution. Future interventions need to target at-risk patients to prevent loss of follow-up after uncertain screening mammogram. K E Y W O R D S diagnostic resolution, uncertain screening mammogram | 3253 KUMAR et Al.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Time to diagnostic resolution after an uncertain screening mammogram in an underserved population

et al. 2020

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“…Authors described openness to collaborating as willingness to participate in multisector partnering (36). In one of the few recent rural studies we found, relationship building, trust building, and shared vision and goals led to a shared valuing of health, while addressing policy and environmental change was a challenge (37). A shared purpose and prior collaboration history facilitated multisector collaboration, while geographic distance and lack of time were barriers in another rural study (10).…”

Section: Alignment With Literaturementioning

confidence: 86%

“…Rural areas need consistent funding and other resources to support health-improving multisector initiatives and counteract the long history of disinvestment in US rural communities ( 7 , 10 , 37 , 38 ). Rural areas need increased funding for prevention programs and services in general as well as increased funding for formal multisector collaborations to collaboratively implement specific initiatives.…”

Section: Implications For Public Healthmentioning

confidence: 99%

Facilitators of Multisector Collaboration for Delivering Cancer Control Interventions in Rural Communities: A Descriptive Qualitative Study

et al. 2022

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Purpose and Objectives Multisector collaboration is a widely promoted strategy to increase equitable availability, access, and use of healthy foods, safe places for physical activity, social supports, and preventive health care services. Yet fewer studies and resources exist for collaboration among governmental and nongovernmental agencies to address public problems in rural areas, despite an excess burden of risk factors for cancer morbidity and mortality. We aimed to learn about cancer prevention activities and collaboration facilitators among rural informal interagency networks. Evaluation Methods In 2020, researchers conducted semistructured interviews with staff from rural public health and social services agencies, community health centers, and extension offices. Agency staff were from 5 service areas across 27 rural counties in Missouri and Illinois with high poverty rates and excess cancer risks and mortality. We conducted a thematic analysis to code interview transcripts and identify key themes. Results Exchanging information, cohosting annual or one-time events, and promoting other agencies’ services and programs were the most commonly described collaborative activities among the 32 participants interviewed. Participants indicated a desire to improve collaborations by writing more grants together to codevelop ongoing prevention programs and further share resources. Participants expressed needs to increase community outreach, improve referral systems, and expand screenings. We identified 5 facilitator themes: commitment to address community needs, mutual willingness to collaborate, long-standing relationships, smaller community structures, and necessity of leveraging limited resources. Challenges included lack of funding and time, long travel distances, competing priorities, difficulty replacing staff in remote communities, and jurisdictional boundaries. Although the COVID-19 pandemic further limited staff availability for collaboration, participants noted benefits of remote collaborative meetings. Implications for Public Health Rural areas need consistent funding and other resources to support health-improving multisector initiatives. Existing strengths found in the rural underresourced areas can facilitate multisector collaborations for cancer prevention, including long-standing relationships, small community structures, and the need to leverage limited resources.

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“…Acting as the "hub", Moncrief also provides community outreach to alert women in rural and underserved communities of the opportunity to receive no-cost mammography services from local partners or through BSPAN mobile mammography events (20,21). In brief, women contact the BSPAN program via a toll-free telephone number in response to advertisements, pamphlets, word-of-mouth outreach, or community events.…”

Section: Methodsmentioning

confidence: 99%

Long-term Mammography Adherence among Uninsured Women Enrolled in the Breast Screening and Patient Navigation (BSPAN) Program

Nair

Lee

Berry

et al. 2022

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: The Breast Screening and Patient Navigation (BSPAN) Program provides access to no-cost breast cancer screening services to uninsured women in North Texas. Using data from the longitudinal BSPAN program (2012–2019), we assessed prevalence and correlates of (i) baseline adherence and (ii) longitudinal adherence to screening mammograms. Methods: Outcomes were baseline adherence (adherent if women received second mammogram 9–30 months after the index mammogram) and longitudinal adherence (assessed among baseline adherent women and defined as being adherent 39 months from the index mammogram). We used multivariable logistic regression and multivariable Cox proportional hazards model to assess associations of sociodemographic and clinical characteristics with baseline and longitudinal adherence, respectively. Results: Of 19,292 women, only 5,382 (27.9%) were baseline adherent. Baseline adherence was more likely among women who were partnered, preferred speaking Spanish, had poor reading ability, had prior Papanicolaou (PAP) testing, and prior screening mammograms, compared with women who were non-partnered, preferred speaking English, had good reading ability, had no prior PAP testing, and no prior screening mammograms, respectively. Of those who were baseline adherent, 4,364 (81.1%) women demonstrated longitudinal adherence. Correlates of longitudinal adherence were similar to those from baseline adherence. Conclusions: A large proportion of baseline adherent women (>80%) achieved longitudinal adherence, which highlights the importance of concentrating resources during the second mammogram in the progression toward continued adherence. Impact: Results from our unique dataset provide realistic mammography adherence rates and may be generalizable to other areas introducing no-cost screening to low-income women, independent of any regular patient-centered medical home.

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Effects of program scale-up on time to resolution for patients with abnormal screening mammography results

Abstract: Expansion maintained timely service delivery, increasing access to screening among rural, uninsured women. Policies adding a separate quality metric for BI-RAD 3 could encourage follow-up monitoring to address lower completion and longer TTR among women with this result.

Cited by 3 publications

References 43 publications

Time to diagnostic resolution after an uncertain screening mammogram in an underserved population

Time to diagnostic resolution after an uncertain screening mammogram in an underserved population

Facilitators of Multisector Collaboration for Delivering Cancer Control Interventions in Rural Communities: A Descriptive Qualitative Study

Long-term Mammography Adherence among Uninsured Women Enrolled in the Breast Screening and Patient Navigation (BSPAN) Program

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