Officer for Community Health and Equity, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
J Am Coll Radiol. 2024 Oct;21(10):1645-1656. doi: 10.1016/j.jacr.2024.03.017. Epub 2024 Apr 8.
Patients who miss screening mammogram appointments without notifying the health care system (no-show) risk care delays. We investigate sociodemographic characteristics of patients who experience screening mammogram no-shows at a community health center and whether and when the missed examinations are completed.
We included patients with screening mammogram appointments at a community health center between January 1, 2021, and December 31, 2021. Language, race, ethnicity, insurance type, residential ZIP code tabulation area (ZCTA) poverty, appointment outcome (no-show, same-day cancelation, completed), and dates of completed screening mammograms after no-show appointments with ≥1-year follow-up were collected. Multivariable analyses were used to assess associations between patient characteristics and appointment outcomes.
Of 6,159 patients, 12.1% (743 of 6,159) experienced no-shows. The no-show group differed from the completed group by language, race and ethnicity, insurance type, and poverty level (all P < .05). Patients with no-shows more often had: primary language other than English (32.0% [238 of 743] versus 26.7% [1,265 of 4,741]), race and ethnicity other than White non-Hispanic (42.3% [314 of 743] versus 33.6% [1,595 of 4,742]), Medicaid or means-tested insurance (62.0% [461 of 743] versus 34.4% [1,629 of 4,742]), and residential ZCTAs with ≥20% poverty (19.5% [145 of 743] versus 14.1% [670 of 4,742]). Independent predictors of no-shows were Black non-Hispanic race and ethnicity (adjusted odds ratio [aOR], 1.52; 95% confidence interval [CI], 1.12-2.07; P = .007), Medicaid or other means-tested insurance (aOR, 2.75; 95% CI, 2.29-3.30; P < .001), and ZCTAs with ≥20% poverty (aOR, 1.76; 95% CI, 1.14-2.72; P = .011). At 1-year follow-up, 40.6% (302 of 743) of patients with no-shows had not completed screening mammogram.
Screening mammogram no-shows is a health equity issue in which socio-economically disadvantaged and racially and ethnically minoritized patients are more likely to experience missed appointments and continued delays in screening mammogram completion.
未通知医疗系统就错过筛查乳房 X 光检查预约的患者（失约）可能会导致护理延误。我们研究了在社区健康中心经历筛查乳房 X 光检查失约的患者的社会人口统计学特征，以及这些失约检查是否以及何时完成。
我们纳入了 2021 年 1 月 1 日至 2021 年 12 月 31 日期间在社区健康中心进行筛查乳房 X 光检查预约的患者。语言、种族和民族、保险类型、居住的邮政编码分区（ZCTA）贫困程度、预约结果（失约、同日取消、完成）以及失约预约后≥1 年完成的筛查乳房 X 光检查日期均被收集。多变量分析用于评估患者特征与预约结果之间的关联。
在 6159 名患者中，有 12.1%（743 名/6159 名）经历了失约。失约组与完成组在语言、种族和民族、保险类型以及贫困程度方面存在差异（均 P <.05）。失约患者更常见的是：主要语言不是英语（32.0% [238 名/743 名] 与 26.7% [1 名/4,741 名]）、种族和民族不是白种非西班牙裔（42.3% [314 名/743 名] 与 33.6% [1 名/5,742 名]）、拥有医疗补助或经济状况调查保险（62.0% [461 名/743 名] 与 34.4% [1 名/6,742 名]）和居住在贫困率≥20%的 ZCTA（19.5% [145 名/743 名] 与 14.1% [670 名/4,742 名]）。失约的独立预测因素包括非裔美国人（调整后的优势比 [aOR]，1.52；95%置信区间 [CI]，1.12-2.07；P =.007）、医疗补助或其他经济状况调查保险（aOR，2.75；95% CI，2.29-3.30；P <.001）以及贫困率≥20%的 ZCTA（aOR，1.76；95% CI，1.14-2.72；P =.011）。在 1 年的随访中，有 40.6%（302 名/743 名）的失约患者尚未完成筛查乳房 X 光检查。
筛查乳房 X 光检查失约是一个公平问题，社会经济处于劣势地位以及种族和民族处于少数地位的患者更有可能错过预约，并继续延迟完成筛查乳房 X 光检查。
