title: Sustaining mammography screening among the medically underserved: a follow-up evaluation.
abstract: BACKGROUND
  Our previous three-arm comparative effectiveness intervention in community clinic patients who were not up-to-date with screening resulted in mammography rates over 50% in all arms.
  
  
  OBJECTIVE
  Our aim was to evaluate the effectiveness and cost-effectiveness of the three interventions on improving biennial screening rates among eligible patients.
  
  
  METHODS
  A three-arm quasi-experimental evaluation was conducted in eight community clinics from 2008 to 2011. Screening efforts included (1) enhanced care: Participants received an in-person recommendation from a research assistant (RA) in year 1, and clinics followed usual clinic protocol for scheduling screening mammograms; (2) education intervention: Participants received education and in-person recommendation from an RA in year 1, and clinics followed usual clinic protocol for scheduling mammograms; or (3) nurse support: A nurse manager provided in-person education and recommendation, scheduled mammograms, and followed up with phone support. In all arms, mammography was offered at no cost to uninsured patients.
  
  
  RESULTS
  Of 624 eligible women, biennial mammography within 24-30 months of their previous test was performed for 11.0% of women in the enhanced-care arm, 7.1% in the education- intervention arm, and 48.0% in the nurse-support arm (p<0.0001). The incremental cost was $1,232 per additional woman undergoing screening with nurse support vs. enhanced care and $1,092 with nurse support vs. education.
  
  
  CONCLUSIONS
  Biennial mammography screening rates were improved by providing nurse support but not with enhanced care or education. However, this approach was not cost-effective.
authors.affiliation: 1 Department of Medicine, Louisiana State University Health Sciences Center , Shreveport, Louisiana.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Connie L
authors.initials: CL
authors.lastname: Arnold
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D003151:Community Health Centers / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006801:Humans; D008145:Louisiana; D008297:Male; D008327:Mammography / Q000191:economics*; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008507:Medically Underserved Area; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010043:Outcome and Process Assessment, Health Care