Characteristics of primary care office systems as predictors of mammography utilization.
OBJECTIVE
To evaluate the association between primary care office systems and mammography utilization by women older than 50 years.


METHODS
Cross-sectional.


METHODS
An independent-practice association health maintenance organization (HMO) in Massachusetts.


METHODS
One hundred thirty-two primary care practices, representing 321 physicians and 4378 women with at least 12 months of recent, continuous assignment to a practice participating in the HMO.


METHODS
Practice characteristics and procedures for mammography referral and follow-up were ascertained by interviews of office managers. For each practice, the proportion of women older than 50 years who received a mammogram during their most recent 12-month period of assignment to the practice was calculated.


RESULTS
Forty-five percent of eligible women received a mammogram during their most recent year of assignment to an HMO practice. In a regression model, use of one particular urban mammography center, group practice, and low percentage of Medicaid patients in the practice were each associated with 9% to 12% higher mammography utilization; use of flowsheets and the scheduling of mammograms by the patients themselves were associated with 7% to 9% higher utilization. Smaller, nonsignificant increases were associated with the use of reminders to patients (5%) and the presence of only internists on staff (5%). The model accounted for 51% of the variation in mammography utilization among practices.


CONCLUSIONS
Mammography utilization among women older than 50 years, in a population in which cost was not a barrier, was related to specific office characteristics. Features of the mammography center, the process for scheduling mammograms, the use of flowsheets to prompt physicians, and the use of reminders to patients are important.
Gann
P
P
Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL 60611.
Melville
S K
SK
Luckmann
R
R
D000368:Aged; D001071:Appointments and Schedules; D003430:Cross-Sectional Studies; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008404:Massachusetts; D008875:Middle Aged; D011216:Practice Management, Medical; D011320:Primary Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D017010:Reminder Systems