McCarthy B D, Yood M U, MacWilliam C H, Lee M J
Center for Clinical Effectiveness, Henry Ford Health System, Detroit, MI 48202, USA.
Am J Prev Med. 1996 Mar-Apr;12(2):91-5.
Mammography has been shown to be effective in decreasing breast cancer mortality. However, not all women receive recommended screening. The purpose of this study was to measure the effect of systemic health care delivery factors and patient demographic factors on the use of mammography among a population of women with insurance coverage for screening mammography. We studied 8,805 women, 50 to 74 years of age, who were members of a health maintenance organization in Michigan during 1992. Data were obtained from computerized patient registration and billing systems. Estimated household income was based on zip code and 1990 U.S. Census information. During the study period, 47% of the entire study population received a mammogram. Among the 4,628 women who did not receive a mammogram, 2,358 (51%) did not have any primary care visits in 1992, or did not have a visit at a time when they were due for mammography. Among women with at least one visit during 1992, 60% received a mammogram. Analysis of this group revealed that Caucasian race, married status, and higher estimated household income were associated with 3%-5% higher mammography rates (in absolute terms); seeing a gynecologist and attending a primary care clinic where mammography was available on site were associated with 10%-11% higher rates; and not having at least one of their primary care visits at a time when due for screening was associated with a 33.5% lower mammography rate. These differences persisted after adjusting for other variables. In this population, factors surrounding health care delivery, such as having an office visit when due for screening, the number of office visits, and having been seen by a gynecologist, had a greater association with mammography use than did demographic factors. A population-based perspective that includes developing outreach strategies for women overdue for screening, who have not visited their health care provider, is as important as further improvements in office-based strategies to increase breast cancer screening.
乳房X线摄影已被证明在降低乳腺癌死亡率方面是有效的。然而，并非所有女性都接受推荐的筛查。本研究的目的是衡量系统性医疗保健提供因素和患者人口统计学因素对有乳房X线摄影筛查保险覆盖的女性群体中乳房X线摄影使用情况的影响。我们研究了1992年期间密歇根州一家健康维护组织中8805名年龄在50至74岁之间的女性。数据来自计算机化的患者登记和计费系统。估计家庭收入基于邮政编码和1990年美国人口普查信息。在研究期间，整个研究人群中有47%接受了乳房X线摄影检查。在未接受乳房X线摄影检查的4628名女性中，2358名（51%）在1992年没有任何初级保健就诊，或者在应进行乳房X线摄影检查时没有就诊。在1992年至少有一次就诊的女性中，60%接受了乳房X线摄影检查。对该群体的分析显示，白人种族、已婚状态和较高的估计家庭收入与乳房X线摄影检查率高出3% - 5%（绝对值）相关；看妇科医生以及在现场可进行乳房X线摄影检查的初级保健诊所就诊与检查率高出10% - 11%相关；而在应进行筛查时没有至少一次初级保健就诊与乳房X线摄影检查率低33.5%相关。在对其他变量进行调整后，这些差异仍然存在。在这个群体中，围绕医疗保健提供的因素，如在应进行筛查时进行门诊就诊、门诊就诊次数以及看妇科医生，与乳房X线摄影检查的使用关联比人口统计学因素更大。基于人群的视角，包括为未就诊的逾期筛查女性制定外展策略，与进一步改进基于门诊的策略以增加乳腺癌筛查同样重要。
