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- Title
Improving Mammography Screening Among the Medically Underserved.
- Authors
Davis, Terry; Rademaker, Alfred; Bennett, Charles; Wolf, Michael; Carias, Edson; Reynolds, Cristalyn; Liu, Dachao; Arnold, Connie
- Abstract
BACKGROUND: We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings. METHODS: A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness. RESULTS: Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10 %. Post intervention screening rates were 55.7 % with enhanced care, 51.8 % with health literacy-informed education and 65.8 % with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95 % Confidence Interval 1.08-1.74, p = 0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone. CONCLUSIONS: Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.
- Subjects
LOUISIANA; MAMMOGRAMS; SAFETY-net health care providers; BREAST cancer diagnosis; CONFIDENCE intervals; MEDICAL care costs
- Publication
JGIM: Journal of General Internal Medicine, 2014, Vol 29, Issue 4, p628
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-013-2743-3