| Description |
Background: Breast cancer is the second most common cause of cancer in women in the United States and the leading cause of death in women in Utah. Diagnosing breast cancer early through screening mammography can prevent breast cancer deaths, and implementing a patient reminder system can improve breast cancer screening rates. Local Problem: This initiative occurred at a private family practice clinic in urban Utah, which serves approximately 19,000 patients annually. The clinic does not have a patient reminder system for breast cancer screening, and many patients are not receiving timely screening in accordance with national recommendations. Methods: This Doctor of Nursing Practice (DNP) evidence-based quality improvement initiative used the Johns Hopkins Evidence-Based Practice Model (JHEBPM) to implement a breast cancer screening reminder system for women aged 40 and older. The patients were identified from a single physician practice in the family clinic. Interventions: This initiative introduced a formal screening reminder tool as a process improvement. The clinic's current reminder process was evaluated through discussions with the quality improvement team. The team created a patient log based on chart reviews to identify women past due for breast cancer screening. A subset of these women received reminders via electronic messages and phone calls. During implementation, the Plan-Do-Study-Act (PDSA) cycle, part of the JHEBPM, was used to refine the process, including addressing incidental findings from chart reviews and automating the reminder process. The author conducted individual interviews with the QI and clinic team after implementation to gather feedback. Post-intervention team interviews gathered feedback regarding initiative feasibility, usability, and satisfaction. Results: Before the process improvement initiative, there were no reminders sent to women who were overdue for breast cancer screening. During the chart reviews, 291 overdue patients were identified. Through the initiative, the team sent a subset of 100 patient reminders, with 50 of these patients receiving both electronic and phone call reminders. A total of 150 reminders were sent, reaching 34.4% of patients who were not up to date with screening. The team recognized the feasibility of expanding this process to other providers but raised concerns about time constraints, limited resources, and the need for additional staff. Regarding usability, the medical assistant (MA) found that sending reminders, although they were not time-consuming, did increase their workload. Overall, the initiative was well received, as it provided an important service to patients. The MA managed the reminder process effectively, demonstrating its potential for sustainability. Conclusion: The electronic reminder process is simple and efficient. Automating MA reminders to notify patients when they are next due for screening will be crucial for sustainability. Long-term use is expected to improve screening rates in average-risk women and enhance follow-up for high-risk patients. The process also has the potential to expand to five additional providers within the same clinic and may be used for other preventive care patient reminders. |
