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The Breast-Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects
Roger T Anderson1,2, Marianne M Hillemeier3, Fabian T Camacho2
1University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA.
Summary
A measurement framework for mammogram facilities in Appalachia was developed and tested. Findings show facility capacity and diagnostic services impact screening uptake, with resource disparities linked to economic status.
Area of Science:
- Radiology and Imaging Science
- Public Health and Epidemiology
- Health Services Research
Background:
- Mammography screening is crucial for early breast cancer detection.
- Understanding facility-level factors influencing screening is vital for improving access and outcomes, particularly in underserved regions like Appalachia.
Purpose of the Study:
- To develop and validate a measurement framework assessing mammogram facility resources, policies, and practices within the Appalachian region.
- To examine the relationship between facility characteristics and mammogram screening uptake.
Main Methods:
- A survey was administered to 192 mammogram facilities across Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia.
- Exploratory and confirmatory factor analyses were used to refine survey items into key domains: capacity, outreach, operational support, radiology review, and diagnostic services.
- Medicare claims data were analyzed to assess construct validity through associations with community characteristics, screening uptake, and market reach.
Main Results:
- Five key factors emerged: capacity, outreach & marketing, operational support, radiology review, and diagnostic services.
- Imaging capacity and diagnostic services were positively associated with mammogram screening uptake.
- Facilities in economically affluent areas possessed more resources and were part of larger health systems compared to those in distressed areas.
- Facilities in economically distressed areas relied more heavily on outreach activities.
Conclusions:
- An 18-item measurement framework was established to assess breast imaging services and facility characteristics.
- Facility capacity and diagnostic services are significant predictors of mammogram screening uptake.
- Disparities in resources and reliance on outreach highlight the need for targeted interventions in economically distressed Appalachian communities.
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