Impact of an Educational Intervention Designed to Reduce Unnecessary Recall during Screening Mammography

Abstract

Purpose To describe the impact of a tailored web based educational program designed to reduce excessive screening mammography recall. Methods Radiologists enrolled in one of four mammography registries in the U.S. were invited to take part and were randomly assigned to receive the intervention or to serve as controls. The controls were offered the intervention at the end of the study, and data collection included an assessment of their clinical practice as well. The intervention provided each radiologist with individual audit data for their sensitivity, specificity, recall rate, PPV and cancer detection rates compared to national benchmarks and peer-comparisons for the same measures; profiled breast cancer risk in each radiologist’s respective patient populations to illustrate how low breast cancer risk is in population based settings, and evaluated the possible impact of medical malpractice concerns on recall rates. Participants’ recall rates from actual practice were evaluated for three time periods: the nine months before the intervention was delivered to the Intervention Group (baseline period), the nine months between the Intervention and Control Groups (T1) and nine months after Completion of the intervention by the Controls (T2). Logistic regression models examining the probability a mammogram was recalled included indication of intervention versus control and the time periods (baseline, T1, T2). Interactions between the groups and time period were also included to determine if the association between time period and the probability of a positive result differed across groups. Results Thirty-one radiologists who completed the CME were included in the adjusted model comparing radiologists in the Intervention Group (n=22) to radiologists who completed the intervention in the Control Group (n=9). At T1 the Intervention Group had 12% higher odds of a positive mammogram compared to the Controls, after controlling for baseline (OR=1.12, 95% CI=1.00-1.27, p=0.0569). At T2 a similar association was found; however, it was not statistically significant (OR=1.10, 95% CI=0.96-1.25). No associations were found among radiologists in the Controls when comparing those who completed the CME (n=9) to those who did not (n=10). In addition, we found no associations between time-period and recall rate among radiologists who set realistic goals. Conclusions In conclusion, our study resulted in a null effect, which may indicate a single one-hour intervention is not adequate to change excessive recall among radiologists who undertook the intervention we were testing.

Effectiveness of guideline dissemination and implementation strategies on health care professionals’ behaviour and patient outcomes in the cancer care context: a systematic review

“…The RCTs reviewed had moderate to high risk of bias; study quality was primarily limited by a lack of blinding and allocation concealment (see Table 2). All quasi-experimental studies were judged to have an overall serious Ayanian et al [29] Burack et al [31] Carney et al [32] Du Pen et al [35] Du Pen et al [36] Emery et al [37] Ferreira et al [38] Ganz et al [39] Gorin et al [40] Hillman et al [41] Kerfoot et al [43] Lane et al [45] Ling et al [46] Manfredi et al [47] McDonald et al [48] Myers et al [27] Myers et al [26] Ornstein et al [49] Rat et al [53] Roila et al [56] Sequist et al [57] risk of bias; study quality was primarily limited by inappropriate measurement of outcomes, missing data, and the presence of confounding variables (see Table 3).…”

Educational Interventions to Improve Screening Mammography Interpretation: A Randomized Controlled Trial

“…Our report is only the second published study to use a randomized controlled design for interventions to improve mammography interpretive performance (28). Although only 102 radiologists completed our study, it is the largest to date designed to measure improved mammography performance.…”

“…Although only 102 radiologists completed our study, it is the largest to date designed to measure improved mammography performance. Carney et al(28) tested a 1.5-hour Internet-based CME designed to decrease recall rate. Participation was very low and no differences were found between the control and intervention group as measured by pre- and post-clinical recall rate (28).…”

The impact of social norms interventions on clinical behaviour change among health workers: protocol for a systematic review and meta-analysis

“…A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. These social norms interventions can form part of an audit and feedback initiative [10–12] or may be developed as another behaviour change intervention [13]. These are interventions with reach that can be implemented routinely across multiple health workers and settings at low cost, so the absolute gain can be very large.…”