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Trock B , Rimer BK , King E , Balshem A , Suzanne Cristinzio C , Engstrom PF
Impact of an HMO-based intervention to increase mammography utilization
Cancer Epidemiology Biomarkers and Prevention. 1993 ;2(2) :151-156
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A health maintenance organization (HMO)-based program designed to increase breast cancer screening was evaluated, focusing on changes in mammography utilization. The program consisted of a multistage intervention aimed at women members and primary care physicians of the HMO. This report examines the effect of the intervention on mammography utilization. The program was evaluated using a quasiexperimental design in which a random sample of women aged 50-74 from the HMO (intervention) was compared to a similarly aged geographic control group selected through random digit dialing. From 1988 to 1990, 450 intervention women and 450 control women were sampled (without replacement) each year and surveyed about breast cancer screening practices and related knowledge. A clear increase in self-reported mammography utilization was associated with the intervention. The percentage of women who reported a mammogram in the 12 months prior to the survey increased from 41% in 1988 (baseline) to 68% in 1990 among HMO women, compared to a change from 39% to 49% among control women. Comparing postintervention rates of mammography in HMO versus control women yielded a rate ratio (RR) of 1.4. However, this effect was strongly modified by income and race. Women with annual incomes of $31,000 or more showed little (whites, RR = 1.2) or no (blacks, RR = 1.0) effect of the intervention. Among women with incomes less than $31,000, the effect among whites (RR = 1.9) was much stronger than among blacks (RR = 1.2).
10559965 (ISSN) Cited By: 32; Export Date: 31 May 2006; Source: Scopus CODEN: CEBPE Language of Original Document: English Correspondence Address: Trock, B.; Biostatistics and Epidemiology; Lombardi Cancer Research Center; Georgetown University; 4000 Reservoir Road NW Washington, DC 20007, United States References: (1991) Cancer Facts and Figures 1991, New York: American Cancer Society; Wertheimer, M.D., Costanza, M.E., Dodson, T.F., D'Orsi, C., Pastides, H., Zapka, J.G., Increasing the effort toward breast cancer detection (1986) JAMA, 255, pp. 1311-1315; Shapiro, S., Venet, W., Strax, P., Venet, L., Roeser, R., 10-14 year effect of screening on breast cancer mortality (1982) J. Natl. Cancer Inst., 62, pp. 349-355; Tabar, L., Gad, A., Holmberg, L., Reduction in mortality from breast cancer after mass screening with mammography (1985) Lancet, pp. 829-832; Dawson, D., Thompson, G.B., Breast Cancer Risk Factors and Screening: United States, 1987 (1990) DHHS Publication No. (PHS) 90-1500, pp. 1-33, Hyattsville, MD: U.S. Department of Health and Human Services; Marchant, D.J., Sutton, S.M., Use of mammography-United States, 1990 (1990) Morbidity Mortality Weekly Rep., 39, pp. 621-630; Screening mammography: A missed clinical opportunity? (1990) JAMA, 264, pp. 54-58; Fox, S.A., Stein, J.A., The effect of physician-patient communication on mammography utilization by different ethnic groups (1991) Med. Care, 29, pp. 1065-1082; Howard, J., Using mammography for cancer control: An unrealized potential (1987) CA Cancer J. Clin., 37, pp. 33-48; Rimer, B.K., Track, B., Lerman, C., King, E., Engstrom, P.F., Why do some women get regular mammograms? (1991) Am. J. Prev. Med., 7, pp. 76-81; Zapka, J.G., Stoddard, A., Maul, L., Costanza, M.E., Interval adherence to mammography screening guidelines (1991) Med. Care, 29, pp. 697-707; Rimer, B.K., Keintz, M.K., Kessler, H.B., Engstrom, P.F., Rosan, J.R., Why women resist screening mammography: Patient-related barriers (1989) Radiology, 172, pp. 243-246; Lerman, C., Rimer, B., Trock, B., Balshem, A., Engstrom, P.F., Factors associated with repeat adherence to breast cancer screening (1990) Prev. Med., 19, pp. 279-290; Coll, P.P., O'Connor, P.J., Crabtree, P.F., Besdine, R.W., Effects of age, education, and physician advice on utilization of screening mammography (1989) J. Am. Geriatr. Soc., 37, pp. 957-962; Burg, M.A., Lane, D.S., Poledmak, A.P., Age group differences in the use of breast cancer screening tests (1990) J. Aging Health, 2, pp. 514-530; Lerman, C., Trock, B., Rimer, B.K., Boyce, A., Jepson, C., Engstrom, P.F., Psychological and behavioral implications of abnormal mammograms (1991) Ann. Intern. Med., 114, pp. 657-661; Rosenstock, I.M., The health belief model: Explaining health behavior through expectancies (1990) Health Behavior and Health Education, pp. 39-62, K. Glanz, F. M. Lewis, and B. K. Rimer (eds.). San Francisco: Jossey-Bass; King, E.S., Rimer, B.K., Trock, B., Balshem, A., Engstrom, P., How valid are mammography self-reports? (1990) Am. J. Public Health, 80, pp. 1386-1388; Kleinbaum, D.G., Kupper, L.L., Morgenstern, H., (1982) Epidemiologic Research: Principles and Quantitative Methods, New York: Van Nostrand Reinhold Company; Snedecor, G.W., Cochran, W.G., (1976) Statistical Methods, Ames, IA: Iowa State University Press.