Enabling Characteristics of Mammography Facilities: Disparities Based on Racial/Ethnic Composition of Location

Rationale: Women in locations with large minority populations are less likely to have a periodic screening mammogram than women in affluent high-white locations. While proximity to facilities may explain some of the differences in utilization, little is know about whether facilities in high-minority locations are less likely to have "enabling characteristics" that facilitate access and use of services by their clientele. Enabling characteristics of care providers are a major component of the standard conceptual framework used to study access to care. However, they have received remarkably little empirical study although the literature on access is large. Objectives: To examine if mammography facilities that locate in minority areas have less convenient hours, do less to assure that patients return, and perform less outreach in the community. Methodology: We will conduct a telephone survey of mammography facilities. The facilities to survey will be sampled from the FDA/ACR complete listing of mammography facilities. Office managers are the target respondents; when they cannot be reached, the survey will be addressed to front office staff who make appointments. The survey will collect data on facility characteristics that promote or ease use of the facility, such as whether the facility is open extended hours, accepts charity patients, performs outreach in the community, and has non-English speaking staff. In addition, the survey will collect data on general facility characteristics, such as whether the facility is academic or not and number of patients seen per week. Data from the U.S. census will be used to measure the racial/ethnic composition and demographic and socioeconomic characteristics of the location of the facility. Results: A pilot survey was conducted on 105 facilities. Descriptive statistics indicate that facilities in heavily-minority zip codes have, if anything, slightly more numerous enabling characteristics. In particular, they are far more likely to have non-white staff and staff members who speak languages other than English. Also, they are somewhat more likely to accept charity patients (in heavily black and heavily Asian zip codes), and use posters and flyers for outreach (in heavily black and heavily Hispanic zip codes). Evening and weekend hours are sparse in all settings. Almost no facilities make next year's appointment when the patient is present for this year's mammogram. Very few facilities carry on outreach to primary care physicians. Only half or fewer of facilities in heavily minority zip codes participate in a CDC program that provides free mammograms for poor women. Conclusion: Preliminary results indicate that mammography facilities serving minority areas are no less committed to patient care than facilities in high-white neighborhoods. Our larger-scale survey will show whether the pilot study's findings are borne out in a multivariable model that, because of larger sample size, can include many neighborhood socioeconomic and demographic controls. If so, it will ascertain in just what ways facilities in heavily minority neighborhoods do more to enable access than those in predominantly white neighborhoods.