Redesigning primary care processes to improve the offering of mammography. The use of clinic protocols by nonphysicians

Journal of General Internal Medicine
B D McCarthyM J Young

Abstract

To develop, within the framework of continuous quality improvement, new processes for offering mammography and determine whether protocols executed completely by nonphysicians would increase mammography utilization. A prospective follow-up study with patients from an intervention clinic and two control clinics. Three general internal medicine clinics in a large, urban teaching hospital in Detroit, Michigan. A total of 5,934 women, aged 40 through 75 years, making 16,546 visits to one of the clinics during the study period (September 1, 1992, through November 31, 1993). Medical assistants and licensed practical nurses in the intervention clinic were trained to identify women due for screening mammography, and to directly offer and order a mammogram if patients agreed. Patients were considered up-to-date with screening if they had a mammogram within 1 year (if age 50-75) or 2 years (if age 40-49) prior to the visit or a mammogram within 60 days after the visit. The proportion of visits each month in which a woman was up-to-date with mammography was calculated using computerized billing records. Prior to the intervention, the proportion of visits in which women were up-to-date was 68% (95% confidence interval [CI] 63%, 73%) in the...Continue Reading

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May 27, 1999·Journal of Nursing Care Quality·C A CalomeniS A Conn
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