title: The effect of a comprehensive breast screening program on self-reported mammography use by primary care physicians and women in a health maintenance organization.
abstract: BACKGROUND
  Mammography use is increasing in the United States, but most women older than 50 years still are not being screened regularly. A multicomponent program, with components for women and physicians, was conducted to increase screening among women aged 50 to 74 years in an independent practice association (IPA)-model health maintenance organization (HMO).
  
  
  METHODS
  The participating women and physicians were surveyed in four waves to evaluate the program. We report on changes in mammography practices by both women and physicians between 1988 (preintervention year) and 1992 (postintervention year). Bivariate and multivariate analyses were calculated.
  
  
  RESULTS
  The proportion of responding HMO physicians who recommended annual mammograms for women aged 50 to 74 years increased by 16 percent from 1988 to 1992 compared with an increase of 10 percent for control group physicians (nonsignificant). There was a 30 percent increase from 1988 to 1992 in the proportion of HMO women respondents who reported having had a mammogram in the past year compared with a 19 percent increase among control group women. The difference between these differences was highly significant. The intervention had the strongest effect on women with incomes of less than $30,000.
  
  
  CONCLUSIONS
  A multicomponent program in an IPA-model HMO resulted in significant increases in the proportion of HMO women who had mammograms. Similar approaches should be tested in other settings.
authors.affiliation: Duke Comprehensive Cancer Center, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: B K
authors.initials: BK
authors.lastname: Rimer
authors.forename: E
authors.initials: E
authors.lastname: Ross
authors.forename: A
authors.initials: A
authors.lastname: Balshem
authors.forename: P F
authors.initials: PF
authors.lastname: Engstrom
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D003710:Demography; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007182:Income; D007193:Independent Practice Associations; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation