335214
Patterns of variation in quality of screening mammography in a safety-net health system
Objective: To evaluate quality of screening mammography within a safety-net health system and identify factors that may contribute to patterns of variation in quality data.
Methods: We conducted a retrospective abstraction of quality data for all screening mammograms completed at three sites (Site A, B, C) in 2013 within a safety-net health system in Chicago. Data was aggregated into a standardized set of metrics and compared to local quality benchmarks. Potential factors were identified to explain patterns in data that deviate from standards.
Results: In 2013, 5329 women received screening mammograms. Site A had a recall rate (13%) and biopsy recommendation rate (10%) that met quality standards, however a low cancer detection rate (1-2 per 1000). This site served a younger, largely Hispanic, and well-screened population that may have a low cancer detection rate despite meeting other quality benchmarks. Site B had a low recall rate (3.4%), high biopsy recommendation rate (29%), and low cancer detection rate (2-3 per 1000). This pattern suggests missed findings on screening mammogram due to poor radiologist/technical quality. Site C reported a high recall rate (18%), high biopsy recommendation rate (21%) and high normal cancer detection rate (10 per 1000) possibly reflecting screening for a predominantly high-risk patient population.
Conclusions: There was wide variation in quality of screening mammography within one institution. Understanding patterns in deviations of quality data may help sites identify modifiable factors to improve quality across a system.
Learning Areas:
Provision of health care to the publicPublic health or related organizational policy, standards, or other guidelines
Learning Objectives:
Identify key quality metrics for screening mammography.
Describe factors that contribute to deviation of quality data from standards for screening mammography.
Keyword(s): Cancer Prevention and Screening, Quality of Care
Qualified on the content I am responsible for because: I am a preventive medicine fellow who participates in system-level planning of cancer screening services and involved in efforts to improve institutional quality of screening mammography.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.