Document Type

Conference Proceeding

Publication Date


Publication Title

J Gen Intern Med


STATEMENT OF PROBLEM/QUESTION: Structural barriers such as obstacles in scheduling appointments can prevent patients from receiving appropriate cancer screenings.

DESCRIPTION OF PROGRAM/INTERVENTION: This study is a quality improvement (QI) project designed to increase completion rates of breast cancer screening. We use a multidisciplinary team-based care approach in our outpatient, academic clinic. Our annual clinic volume is about 40,000 visits and 74% of our patients are African Americans. In our practice, a workflow is in place to allow medical assistants to pend certain orders pertaining to health maintenance including mammograms which are then signed by providers if deemed appropriate. Prior to our intervention, when a mammogram was ordered for a patient, the medical assistant provided the phone number to the patient to schedule their appointment after leaving the clinic. Our intervention was to use our secretaries to schedule the mammogram during check-out, prior to the patient leaving the clinic.

MEASURES OF SUCCESS: To determine the effectiveness of our intervention, we analyzed the overall mammogram completion rates eight months prior and eight months after the intervention. Statistical analysis was completed by comparing the difference in the slopes prior and after intervention.

FINDINGS TO DATE: Over the sixteen-month period of this study, an average of 4,843 patients were due for their mammogram. The average completion rate of mammograms prior to the intervention was 68.4% compared to 74.1% after the intervention. Prior to the intervention, the completion rate slope was 0.44 and the standard error (SE) of the regression slope was 0.02. After the intervention, the slope was 0.74 and the SE of the regression slope was 0.12. The t-statistic was 2.6 and the p-value was 0.02.

KEY LESSONS FOR DISSEMINATION: Mammogram allows for effective identification of pre- cancerous lesions and early identification of malignancy. The goal of this QI project was to reduce structural barriers by creating a simplified process for scheduling mammograms. Our intervention to reduce barriers to mammography scheduling showed a statistically significant improvement in mammography completion. This study demonstrates that simple organizational changes can have a significant impact on patient outcomes.



First Page