Abstract
6563 Background: Failure to obtain follow-up (f/u) of abnormal mammograms may delay cancer diagnosis and impact outcome; studies show up to 20% of women do not get recommended f/u. Our group previously established that administrative claims linked to medical records accurately identify care for management of abnormal mammograms. We are testing a case management system linking claims data to mammogram information to assist physicians in assuring appropriate f/u for abnormal mammograms. Methods: Electronic medical records in a staff model practice affiliated with a single payer are scanned to identify the BI-RADS code for all mammograms. The practice performs about 8,000 mammograms with about 500 abnormal mammograms annually. Physicians are notified of each abnormal mammogram and provided with a standardized care pathway for management. For each BI-RADS 0, 3, 4 or 5 mammogram, claims are searched for f/u breast procedures (imaging, biopsy, surgery). If recommended f/u (additional imaging for BI-RADS 0, biopsy by 2 months for BI-RADS 4 and 5, f/u imaging by 8 months for BI-RADS 3) is not observed, the ordering physician is alerted. Results: From 01/01/2001 to 12/31/2003, we observed that among women eligible for f/u, 189 (16%) did not receive BI-RADS recommended f/u care. In the prospective intervention from 1/1/06 - 6/30/06, 166 BI-RADS 0, 21 BI-RADS 4, and 3 BI-RADS 5 mammograms had 98.2%, 76.2%, and 100% appropriate f/u, respectively. From the alerts, all but one patient who refused biopsy received appropriate care. Conclusions: A practice intervention utilizing BI- RADS data linked to claims accurately identified missed f/u in a time frame when appropriate care can be delivered. This practice-based intervention has potential to improve the management of other cancers and chronic diseases. This intervention is being expanded on a community wide level. No significant financial relationships to disclose.
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