Multidisciplinary Approach to Improving Breast Cancer Screening

Navigating changes over the past couple of years has been a stretch for many in healthcare as we pave the path to a new normal. This journey is an opportunity to evaluate historical practices and expand improvements in care delivery. Strategically defining and targeting areas is often the first step in this journey.

Organizationally, we have defined core clinical quality metrics as a guiding post for driving these improvements. In the imaging space, one of these cores clinical quality metrics is supporting the breast cancer screening compliance rate for women between the ages of 40 and 74, as it plays a critical role in early detection. Successfully moving the mark on breast cancer screening compliance has been accomplished through a variety of tactics in a multidisciplinary approach.

Quality tracking

• Development of a quality dashboard and weekly tracking of progress

• Shared organizational goals

• Standardized tools for quality reporting

Driving a culture of quality-based initiatives is supported through a robust dashboard and regular reporting. It allows all key stakeholders to have a line of site-to-system, regional and site-based performance on defined organizational goals and targets. Individuality account for organizational goals and targets. Individual accountability for performance-improvement opportunities can be developed and supported through tracking tools.

Increased access and expansion of 3D services

• Targeted scheduling tactics

• Expansion of MyChart messaging o Self-scheduling

• Centralized scheduling

• Market assessment for service location preference

• Expanded imaging through rural areas with mobile imaging

Improvements in scheduling led to a significant increase in breast cancer screening exams. Historically, reminder letters were the primary method of communication. While these continue to be standard practices, additional communication tactics were added with functionality within the EHR. MyChart messaging and personal device notices based on individual patient preferences have been quite successful. The alignment of information in these messages with the new self-scheduling functionality has been well received by patients. Standing up a single scheduling work queue for all locations within the organization and carving out a resolute scheduling team with a singular focus has led to the timely scheduling of patients at their preferred location of service.

Utilizing compliance rates, geography, scheduling metrics and patient-experience data to drive service locations as well as imaging schedules has been effective. At existing mammography locations, adjustments to hours of service and staffing models were optimized to offer screenings. Schedule availability is shared daily with primary care clinics for offering same-day screening.

Nearly all of the existing mammography screening equipment within our facilities has been upgraded to provide 3D mammography.Fixed equipment and staffing were targeted for locations that can support a 4 to 5-day-per-week service. 3D mobile mammography was introduced to our market to bring screening services to a number of rural communities where compliance rates were struggling. Locations were identified based on target patient groups in addition to distance to the next available service. Work continues with community partners to identify target populations that have been historically underserved.

Partnering with Primary Care

• Embedded comprehensive care review and shared decision making

• Alignment of screening for high-risk patients

• Clinical outreach targeting non[1]compliant patients

• Locally promoting women’s health events

The partnership between quality, imaging and primary has been the key driver in the screening compliance improvements. Each time a patient is seen in the primary care space, a review of a number of care-delivery questions are reviewed that can prompt clinical conversations around the importance of preventative care measures, including breast cancer screening.

Collaboration between primary care and radiology has led to a shared decision tool that supports appropriate screening for an individual patient’s risk factors. Standardizing recommendations and reporting between the two groups reduce confusion for patients. Patients falling outside of established screening guidelines that are not scheduled through standard processes are identified on a quarterly basis and outreach by a primary care clinician or care coordinator to review their status and address any concerns.

Creating a fun event, primary care[1]hosted women’s health event offers one-time screening opportunities for evening or weekend hours and are well received and high participation at locations where we offer onsite screening and plan to expand services at additional locations using mobile mammography.