Department of Radiological Sciences, University of California, Irvine, Orange, California.
Department of Radiological Sciences, University of California, Irvine, Orange, California; Director of Breast Imaging, University of California, Irvine.
J Am Coll Radiol. 2024 Jan;21(1):147-153. doi: 10.1016/j.jacr.2023.06.027. Epub 2023 Jul 27.
The aim of this study was to assess the rate of self-scheduling and self-referral for screening mammography and to assess sociodemographic factors associated with their use in an academic health care system in southern California.
Patients scheduled for screening mammography between February 1, 2021, and September 20, 2022, were included in this retrospective study. Multivariable logistic regression models were used to assess associations among sociodemographic factors, self-referral, and online self-scheduling pathways.
In total, 22,306 patients were scheduled for screening mammography (mean age, 59 years; 66.8% White, 20.4% Asian, and 20.6% Hispanic). Overall, 3,566 (16.0%) used online self-scheduling, and 1,232 (5.5%) self-referred for screening mammography. Patients 70 years or older (versus 50 years or younger) (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.34-0.51), Spanish (versus English) speakers (OR, 0.22; 95% CI, 0.16-0.31), and those on Medicaid (versus commercially insured) (OR, 0.71; 95% CI, 0.50-0.99) were less likely to self-schedule. Hispanic patients (versus non-Hispanic) (OR, 1.39; 95% CI, 1.20-1.61), Asian patients (versus White) (OR, 1.64; 95% CI, 1.46-1.85), and patients residing in the most (versus least) disadvantaged neighborhoods (OR, 1.16; 95% CI, 1.02-1.33) were more likely to self-schedule. Furthermore, patients 70 years or older (versus 50 or younger) (OR, 0.70; 95% CI, 0.52-0.93) and Spanish speakers (OR, 0.05; 95% CI, 0.03-0.09) were less likely to self-refer, whereas Black patients (versus White) (OR, 1.89; 95% CI, 1.30-2.75), patients on Medicaid (versus commercially insured) (OR, 3.70; 95% CI, 2.65-5.13), and patients living in the most (versus least) disadvantaged neighborhoods (OR, 1.52; 95% CI, 1.27-1.82) were more likely to self-refer.
Sociodemographic differences in online patient portal use and self-referral for screening mammography suggest that the two pathways have been successful in addressing some of the existing scheduling barriers and are a step toward closing the disparity gap.
本研究旨在评估在南加州某学术医疗保健系统中，患者进行乳房 X 线筛查的自我预约和自我转诊率，并评估与这两种方式使用相关的社会人口学因素。
本回顾性研究纳入了 2021 年 2 月 1 日至 2022 年 9 月 20 日期间预约乳房 X 线筛查的患者。采用多变量逻辑回归模型评估社会人口学因素、自我转诊和在线自我预约途径之间的关联。
共有 22306 名患者接受了乳房 X 线筛查（平均年龄 59 岁；66.8%为白人，20.4%为亚洲人，20.6%为西班牙裔）。总体而言，3566 名（16.0%）患者使用了在线自我预约，1232 名（5.5%）患者自我转诊进行乳房 X 线筛查。70 岁及以上（而非 50 岁及以下）的患者（比值比[OR]，0.41；95%置信区间[CI]，0.34-0.51）、西班牙语（而非英语）患者（OR，0.22；95%CI，0.16-0.31）和医疗补助（而非商业保险）患者（OR，0.71；95%CI，0.50-0.99）不太可能进行自我预约。西班牙裔患者（而非非西班牙裔）（OR，1.39；95%CI，1.20-1.61）、亚洲患者（而非白人）（OR，1.64；95%CI，1.46-1.85）和居住在最（而非最不）贫困社区的患者（OR，1.16；95%CI，1.02-1.33）更有可能进行自我预约。此外，70 岁及以上（而非 50 岁及以下）的患者（OR，0.70；95%CI，0.52-0.93）和西班牙语患者（OR，0.05；95%CI，0.03-0.09）不太可能自我转诊，而黑人患者（而非白人）（OR，1.89；95%CI，1.30-2.75）、医疗补助患者（而非商业保险患者）（OR，3.70；95%CI，2.65-5.13）和居住在最（而非最不）贫困社区的患者（OR，1.52；95%CI，1.27-1.82）更有可能自我转诊。
在线患者门户使用和乳房 X 线筛查自我转诊方面的社会人口学差异表明，这两种途径在解决一些现有的预约障碍方面取得了成功，是缩小差距的一步。
