Using EPIC Campaigns to Increase Breast Cancer Screening Completion of Government-Insured and Uninsured Women in a...

The aim of this study was to evaluate EPIC Campaigns (Verona, WI) as a quality improvement initiative to reach our community's uninsured and Medicaid-enrolled patients overdue for screening mammography, describing effectiveness in outreach and factors associated with screening mammography completion.

In March of 2024, screening completion percentages for the Emplify Health by Gundersen patient population were 63.7% for Medicaid patients and 61% for uninsured patients. Using the tool EPIC Campaigns, uninsured or Medicaid-enrolled women aged 40 to 74 years who were overdue for a screening mammogram were identified. Eligible patients were notified of their overdue status via their preferred contact method (patient portal message, text, or postal service) and provided instruction on how to schedule a screening mammogram. Rate of screening completion within 6 months of contact was the central outcome. Rates were analyzed by patient demographics as well as community residence type and social determinants of health (SDOH) using univariate tests-Pearson χ² or Fisher exact-and multiple regression modeling.

We contacted 5,336 women who were overdue for breast cancer screening as of March 2024. Of those, 701 (13%) completed screening mammography within 6 months of our initial contact. The screening completion rate was significantly higher for women on Medicaid versus those who were uninsured (15% versus 6.4%, respectively; P < .001). Screening completion rates were significantly different between community residence types (P = .031). Sixty-eight percent of the study population lived in rural underserved, rural, or rural advantaged communities, the screening completion rates of which were 11% versus 15% versus 14%, respectively. SDOH had varying effects on screening completion rates.

For practices using the EPIC electronic health record, EPIC Campaigns is an outreach option that can be tailored by various parameters to achieve goals such as increasing breast cancer screening completion. Thirteen percent of Medicaid-enrolled and uninsured women who were overdue for breast cancer screening completed breast cancer screening within 6 months of initial contact, with a higher completion rate in Medicaid-enrolled women. Various SDOH affected screening completion.