Abstract P1-02-01: Improvement of breast cancer screening access and quality in an underserved population through system interventions
Authors: Manst DJ , Gil D , Marcus EA , Mullarkey P , Ganschow PS 
Published: May 2019

Abstract
Background: Differences in access to and quality of screening and treatment are proposed to contribute to racial disparities in breast cancer outcomes. Interventions designed to improve mammography access and quality encompass strategies at the individual patient, healthcare provider, and system levels. In 2016, an urban safety net healthcare system based in Chicago implemented several changes in response to collected data showing variations in quality at institutions performing mammography. These changes included the installation of digital machines at one of four sites, centralizing reading of images from all four sites to a single site with radiologists specialized in mammography and increasing care coordination including enhanced patient outreach efforts. We examined the impact of these systems-based interventions on the access to and quality of mammography services.
Methods: Data was obtained on 15,918 screening mammograms performed across four mammography centers within the Cook County Health & Hospitals System from the six months prior to and one year after implementation of changes. Manual chart abstraction was performed for each study that was assessed as BIRADS 0 (Breast Imaging and Reporting Data System), meaning an incomplete study requiring additional imaging evaluation, or mammograms that appeared suspicious or highly suspicious and categorized as BIRADS 4 or 5. Screening mammogram volume at each site was recorded and compared. Quality of screening mammograms was assessed using eleven metrics reflecting radiologist performance and efficiency of facility care processes. These metrics included the rate of recall, cancer detection rate, proportion of cancers that were early stage or minimal in size, proportion of women with timely follow-up imaging and biopsy, and rates of loss to follow-up.
Results: The volume of screening mammograms completed at each of the four sites increased from the six months prior to intervention to the six months after (range of 61-322% increase). At one-year post intervention, there were smaller, but sustained increases in volume (range of 12-70% increase). Improvements were seen in at least one quality metric at each site in the post-intervention period (range 1-8). The proportion of women with timely follow-up after abnormal mammogram also improved across all four sites: from 38% getting follow-up imaging within 30 days pre-intervention to 68% after, and from 62% to 75% of women with biopsy completion within 60 days. Rate of cancer detection improved at two of the sites with the lowest pre-intervention values, from 1.7 to 3.1 and 2.8 to 5.7 per 1,000 mammograms (quality benchmark: 3-10/1,000 screening tests).
Conclusion: Improvements in access to and quality of screening mammography demonstrate the value of implementing system level changes in enhancing breast cancer care and may translate to better outcomes for all women.
Citation Format: Manst DJ, Gil D, Marcus EA, Mullarkey P, Ganschow PS. Improvement of breast cancer screening access and quality in an underserved population through system interventions [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-01.