Q&A: Inpatient mammograms may help reduce screening disparities

Offering mammograms to low-income, hospitalized women who are overdue to receive one helps reduce barriers to screening that they may face in the outpatient setting, according to researchers.

Low-income patients often encounter challenges like lack of transportation and difficulty taking time off from work, and thus, face barriers to scheduling and keeping appointments, Andrew Hwang, MD, MPH, an internist at Massachusetts General Hospital, and colleagues wrote in Annals of Family Medicine.

The researchers conducted a pilot study to determine the value of offering mammograms to hospitalized women who were overdue for breast cancer screening, did not have an outpatient mammogram already scheduled and were insured by Medicaid or both Medicare and Medicaid (dual-eligible patients).

“We designed the study to reach the patients who face significant barriers to completing their mammograms in the outpatient setting,” Hwang said in a press release. “National and local data show that Medicaid and dual-eligible patients have low rates of breast cancer screening.”

The women were identified through the hospital’s electronic record system and approached to participate in the study. Those who could not complete a mammogram due to physical disability, critical illness, altered mental status or were admitted involuntarily for psychiatric emergency or had a limited life expectancy were excluded.

The study included 21 women, of whom 17 were able to schedule and undergo a mammogram before they were discharged from the hospital, the researchers wrote. According to the press release, the average age of these women was 59 years. Sixteen of the mammograms yielded negative results. The remaining mammogram images were deemed “inconclusive” and its recipient was encouraged to undergo additional imaging studies.

“Most patients identified in this pilot [study] would have faced significant psychosocial barriers to completing the mammogram as an outpatient as evident from the fact that 35% never had a screening mammogram previously and patients were, on average, 4 years overdue for their breast cancer screening,” Hwang and colleagues wrote.

Healio Primary Care asked Hwang about barriers to implementing the program, modifying the program during COVID-19 pandemic and more.

Q: What barriers did you encounter when first implementing the program? How can these barriers be overcome?

A: We first had to ensure there were no concerns from a compliance/billing perspective to doing a screening mammogram during a hospitalization. We received the approval to proceed with the pilot [study] after discussing our intervention with the compliance and billing team in our hospital.

Q: How did you get patients to accept and take part in the program?

A: Patients were offered the screening mammogram by the inpatient team caring for the patient. Most women were interested in undergoing the mammogram, except for a few patients who declined.

Q: How might the program need to be modified amid the COVID-19 pandemic?

A: This will depend on where the mammograms are taking place, what precautions are available for the imaging staff and how hospitalized patients are being transported to complete their mammograms. In our hospital, patients would have to be transported to another building and pass through a crowded entryway. To minimize the risk of potentially exposing the breast imaging staff and patients to COVID‐19, we have put the intervention on hold at this time.

Q: What is your message to physicians who are hesitant to implement a similar program?

A: There are certain patients who will struggle to get their preventive care needs addressed in the outpatient setting due to significant psychosocial barriers to care. Our intervention offers one way to help patients who have never completed a mammogram in the past or are significantly overdue for their breast cancer screening.

References:

Hwang AS, et al. Ann Fam Med. 2021;doi.10.1370/afm.2638.

Massachusetts General Hospital press release. Inpatient mammograms can reduce disparities in breast cancer screening rates, https://www.massgeneral.org/news/press-release/Inpatient-mammograms-can-reduce-disparities-in-breast-cancer-screening-rates. Accessed February 3, 2021.