Lester WT et al. 2009 "Mammography FastTrack: an intervention to facilitate reminders for breast cancer screening across a heterogeneous multi-clinic primary care network."
Reference
Lester WT, Ashburner JM, Grant RW, et al. Mammography FastTrack: an intervention to facilitate reminders for breast cancer screening across a heterogeneous multi-clinic primary care network. J Am Med Inform Assoc 2009;16(2):187-195.
Abstract
"Health care information technology can be a means to improve quality and efficiency in the primary care setting. However, merely applying technology without addressing how it fits into provider workflow and existing systems is unlikely to achieve improvement goals. Improving quality of primary care, such as cancer screening rates, requires addressing barriers at system, provider, and patient levels. The authors report the development, implementation, and preliminary use of a new breast cancer screening outreach program in a large multicenter primary care network. This installation paired population-based surveillance with customized information delivery based on a validated model linking patients to providers and practices. In the first six months, 86% of physicians and all case managers voluntarily participated in the program. Providers intervened in 83% of the mammogram-overdue population by initiating mailed reminders or deferring contact. Overall, 63% of patients were successfully contacted. Systematic population-based efforts are promising tools to improve preventative care."
Objective
"The authors report the development, implementation, and preliminary use of a new breast cancer screening outreach program in a large multicenter primary care network. This installation paired population-based surveillance with customized information delivery based on a validated model linking patients to providers and practices."
Tools Used
Type Clinic
Primary care
Size
Small, medium and large
Geography
Urban and suburban
Other Information
The Massachusetts General Primary Care Network (MGPCN) is comprised of 14 practices.
Type of Health IT
Disease registry
Type of Health IT Functions
The authors developed a Web-based application suite including "(1) a population-at-risk registry with aggregated and contextually complete clinical and billing data, (2) a process to periodically update the registry to account for the dynamic nature of population management in the setting of day-to-day care, [and] (3) several user-specific front-end interfaces."
Context or other IT in place
"All practices use electronic medical records (3 distinct systems) and have the same electronic billing and scheduling systems."
Workflow-Related Findings
"The user interfaces of MFT were designed for ease of use ... Voluntary PCP use of MFT was high, with over 85% of physicians screening at least some proportion of the population. Because physician use of this tool was entirely voluntary, ongoing system usage may be considered a key measure of success."
"The interface supported screening workflow in that delegates used this interface to: (1) schedule mammogram appointments directly via the hospital's [W]eb-based radiology order entry system, (2) provide documentation for completed tests or informed patient refusals, and (3) documented when multiple telephone calls were made without patient contact."
"Prior to implementation, there were no systematic efforts to identify or send reminders to patients overdue for mammography screening. By addressing barriers to care at the clinical system, individual provider, and patient levels, MFT, through voluntary use, resulted in over 85% of network physicians and case managers across all practices to take action on 83% of our mammogram-overdue population. Over 63% of the mammogram-overdue population was successfully contacted by letter within the first six months of use."
Study Design
Story
Study Participants
"Mammography FastTrack (MFT) was implemented for continuing use in six practices within our primary care network, with a total of 64 primary care physicians users and six case managers acting on behalf of 3,054 overdue patients."