The Impact of a Physician Intervention Program on Older Women's Mammography Use

Abstract

The Mammography Optimum Referral Effort (MORE) is a physician office-based intervention program initiated by the Connecticut PeerReview Organization (CPRO)to increase mammography use among older women in Connecticut. Three locales in the state were targetedfor the MORE intervention based on identified low mammography rates in women aged 65 years and older Thirty-seven physicians participated from March 1, 1996, to August 31, 1996. Annual mammography rates were derived by merging Medicare Part B mammography claims with a database from the Connecticut TumorRegistry. This strategy allowed us to exclude women with a prior history of breast cancer from the analysis, in order to estimate screening rates. The MORE intervention was associated with an absolute increase of 5.9%6, which represents a relative increase of 15.4%, in annual mammography use. Ourfindings suggest that a multifaceted physician intervention is capable of increasing mammography use among older women.

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References

AMC Cancer Research Center . (1992). Breast and cervical screening: Barriers and use among specific populations. A Literature Review. Denver, CO.: Author.

AMC Cancer Research Center . (1992, June, to 1993, May). Breast and cervical screening: Barriers and use among specific populations. A Literature Review (Suppl. No. 2). Denver, CO.: Author.

Blustein, J. (1995). Medicare coverage, supplemental insurance, and the use of mammography by older women. New England Journal of Medicine, 332, 1138-1143.

Breen, N. , & Kessler, L. (1994). Changes in the use of screening mammography: Evidence from the 1987 and 1990 National Health Interview Surveys. American Journal of Public Health, 84,62-67.

Caplan, L. S. , Wells, B. L. , & Haynes, S. (1992). Breast cancer screening among older racial/ethnic minorities and Whites: Barriers to early detection. Journals of Gerontology, 47, 101-110.

Coll, P. P. , O'Connor, P. J. , Crabtree, B. F. , Besdine, R. W. (1989). Effects of age, education, and physician advice on utilization of screening mammography. Journal of the American Geriatrics Society, 37,957-962.

Davis, D. A. , Thomson, M. A. , Oxman, A. D. , & Haynes, B. (1995). Changing physician performance: A systematic review of the effect of continuing medical education strategies. Journal of theAmerican Medical Association, 274, 700-705.

Fox, S. A. , Murata, P. J. , & Stein, J. A. (1991). The impact of physician compliance on screening mammography for older women. Archives of Internal Medicine, 151, 50-56.

Harris, R. P. , Fletcher, S. Q. , Gonzalez, J. J. , Lannin, D. R. , Degnan, D. , Earp, J. A. , & Clark, R. (1991). Mammography and age: Are we targeting the wrong women? Cancer, 16, 2010-2014.

10.

Health Care Financing Administration . (1995 and 1996). Medicare Managed Care Contract Report. Baltimore, MD: Author.

11.

Healthy People 2000 . (1991). National health promotion and disease prevention objectives. U.S. Department of Health and Human Services, Public Health Services, Washington, DC. DHHS Publication No. PHS 91-50212.

12.

Kerlikowske, K. , Grady, D. , Rubin, S. M. , Sandrock, C. , & Ernster, V.L. (1995). Efficacy of screening mammography: A meta-analysis. Journal of the American Medical Association, 273(2), 149-154.

13.

National Committee for Quality Assurance . (1995). Medicaid Health Plan Employer Data and Information Set 2.5. Washington, DC: Author.

14.

Preston, J. A. , Scinto, J. D. , Weijia, N. , Yun, W. , Galusha, D. , Schulz, A. F. , & Petrillo, M. K. (1997). Mammography underutilization among older women in Connecticut. Journal of the American Geriatrics Society, 45, 1310-1314.

15.

SAS Institute, Inc. (1997). SAS language and procedures (Version 6, 1st ed.). Cary, NC: Author.

16.

Smith, R. A. , & Haynes, S. (1992). Barriers to screening for breast cancer. Cancer, 69, 1968-1978.

17.

Use of mammography services by women aged 2 65 years enrolled in Medicare-United States, 1991-1993 . (1995). MMWR Morb Mortal Weekly Report, 44, 777-781.

18.

Weinberger, M. , Saunders, A. F. , Samsa, G. P. , Bearon, L. B. , Gold, D. T. , Brown, J. T. , Booher, P. , & Loehrer, P. J. (1991). Breast cancer screening in older women: Practices and barriers reported by primary care physicians. Journal of the American Geriatrics Society, 39, 22-29.