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Improving Rescreening In Community Clinics: Does A System Approach Work?

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Abstract

Community clinics provide inadequate breast cancer screening services to low-income, racially- and ethnically-diverse communities. This study develops and evaluates the effectiveness of multifaceted organizational system interventions—operational assessments, tracking systems, reminder calls, tailored education, physician prompts and a tailored counseling call—on mammography rescreening rates within three community clinics. We used the Chronic Care Model and Put Prevention Into Practice framework to redesign breast screening delivery services within the California Cancer Detection Programs: Every Woman Counts(CDP:EWC), community clinic settings. We used a quasi-experimental design with a random selection of 400 patients at pre-intervention. To establish a post-intervention clinic’s rescreening rate a new comparable cross-sectional random sample of 347 women was drawn.

Measures

A chart abstraction instrument was used to establish clinics’ rescreening rates.

Subjects

Participants at pre and post-intervention were low-income women 50 years of age and older who had received normal mammography results and had not been diagnosed with breast cancer in the last five years. General linear mixed model analysis revealed significant improvements for the organizational system redesign condition [pre-intervention rescreening rate: 32.1 percent v. post-intervention rescreening rate 50.2 percent, (p < .001)]. For the organizational system redesign plus tailored counseling call condition, there was maintenance in the rescreening rate following the intervention [pre-intervention: 44.4 percent v. post-intervention: 45.1 percent, (p > 0.05)]. Multilevel interventions directed at redesigning community clinics primary care breast cancer screening services, can improve mammography rescreening rates.

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Acknowledgments

We would like to thank Fabio Sabogal for his helpful insights and recommendations, Norman Fineman for his invaluable assistance with editing, and Laurel Haeusslein for her multiple contributions that included coordinating administrative functions, editing recommendations, and conducting literature searches. We also wish to thank our statistics interns, Lindsey Aldag and Madhu Iyer who helped to create the tables, as well as Lance Pollack and Alison Canchola and various anonymous reviewers who gave excellent suggestions for improvement of the manuscript.

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Authors and Affiliations

  1. Institute for Health and Aging, University of California, San Francisco, P. O. Box 0646, Laurel Heights Campus, San Francisco, CA, 94143-0646, USA

    Regina Otero-Sabogal PhD & Jesse Canchola MS

  2. Resource Center on Aging, University of California, Berkeley, 535 University Hall, Berkeley, CA, 94720, USA

    Desi Owens MS, LCSW

  3. California Department of Health Services, Cancer Detection Section, MS 7203, 1616 Capitol Avenue, Suite 74.421, P.O. Box 997413, Sacramento, CA, 95897-7413, USA

    Farzaneh Tabnak PhD

Authors
  1. Regina Otero-Sabogal PhD
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  2. Desi Owens MS, LCSW
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  3. Jesse Canchola MS
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  4. Farzaneh Tabnak PhD
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Corresponding author

Correspondence to Regina Otero-Sabogal PhD.

Additional information

This study was funded by the California Department of Health Services, Cancer Detection Section. Contract # 00-90917.

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Otero-Sabogal, R., Owens, D., Canchola, J. et al. Improving Rescreening In Community Clinics: Does A System Approach Work?. J Community Health 31, 497–519 (2006). https://doi.org/10.1007/s10900-006-9027-3

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