Beyond the mammography quality standards act: measuring the quality of breast cancer screening programs.

OBJECTIVE: A high-quality screening mammography program should find breast cancer when it exists and when the lesion is small and ensure that suspicious findings receive prompt follow-up. The Mammography Quality Standards Act (MQSA) guidelines related to tracking outcomes are insufficient for assessing quality of care. We used data from a quality improvement project to determine whether screening mammography facilities could show that they met certain quality benchmarks beyond those required by MQSA. MATERIALS AND METHODS: Participating facilities provided aggregate data on screening mammography examinations performed in calendar year 2009 and corresponding diagnostic follow-up, including patients lost to follow-up, timing of diagnostic imaging and biopsy, cancer detection rates, and the proportion of cases of cancer detected as minimal and early-stage tumors. RESULTS: Among the 52 participating institutions, the percentage of institutions meeting each benchmark varied from 27% to 83%. Facilities with American College of Surgeons or National Consortium of Breast Centers designation were more likely to meet benchmarks pertaining to cancer detection and early detection, and disproportionate share facilities were less likely to meet benchmarks pertaining to timeliness of care. CONCLUSION: The results suggest a combination of quality of care issues and incomplete tracking of patients. To accurately measure the quality of the breast cancer screening process, it is critical that there be complete tracking of patients with abnormal screening mammography findings so that results can be interpreted solely in terms of quality of care. The MQSA guidelines for tracking outcomes and measuring quality indicators should be strengthened for better assessment of quality of care.

Black-White health disparities in the United States and Chicago: a 15-year progress analysis.

OBJECTIVES: In an effort to examine national and Chicago, Illinois, progress in meeting the Healthy People 2010 goal of eliminating health disparities, we examined whether disparities between non-Hispanic Black and non-Hispanic White persons widened, narrowed, or stayed the same between 1990 and 2005. METHODS: We examined 15 health status indicators. We determined whether a disparity widened, narrowed, or remained unchanged between 1990 and 2005 by examining the percentage difference in rates between non-Hispanic Black and non-Hispanic White populations at both time points and at each location. We calculated P values to determine whether changes in percentage difference over time were statistically significant. RESULTS: Disparities between non-Hispanic Black and non-Hispanic White populations widened for 6 of 15 health status indicators examined for the United States (5 significantly), whereas in Chicago the majority of disparities widened (11 of 15, 5 significantly). CONCLUSIONS: Overall, progress toward meeting the Healthy People 2010 goal of eliminating health disparities in the United States and in Chicago remains bleak. With more than 15 years of time and effort spent at the national and local level to reduce disparities, the impact remains negligible.

Cancer screening knowledge, attitudes, and behaviors among culturally Deaf adults: implications for informed decision making.

BACKGROUND: Previous studies show that Deaf persons tend to have lower health status, lack health knowledge, have differing health attitudes, and decreased health care utilization when compared to the general population. The authors sought to examine knowledge, attitudes, and behaviors surrounding age- and gender-specific cancer screening tests amongst a sample of Deaf adults who were patients of Deaf-friendly medical organizations. The authors also sought to compare age- and gender-specific cancer screening rates amongst this sample to that of the general US population. METHODS: A sample of 203 adult Deaf patients participated in a comprehensive, face-to-face health survey conducted between November 2002 and March 2003. The survey was administered in American Sign Language by Deaf interviewers and included age- and gender-specific cancer knowledge, attitude, and behavior questions. RESULTS: Knowledge pertaining to Pap smear among females was low, while the proportion having ever had a Pap smear was comparable to the general population. Mammography knowledge amongst females age 50 and older was comparatively higher, although it remained lower than the proportion of females in this age group who reported ever receiving a mammogram. Overall, screening rates for breast, cervical, and colorectal cancer were similar to rates in the general US population. Attitudes toward specific cancer screening tests were also favorable. CONCLUSIONS: Persons within the Deaf community can have cancer screening rates similar to those of the general US population. However, utilization in the absence of knowledge regarding these tests is worrisome and brings about ethical, health care quality and health education concerns.