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Leveraging a Quality and Safety Continuous Process Improvement Framework to Increase Breast Cancer Screening Access.
Pragya Dhar1, Heather Johnston2, Nita Amornsiripanitch3
1Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Journal of the American College of Radiology : JACR
|October 30, 2025
Summary
A digital reminder program modestly reduced screening mammography missed care opportunities. However, SMS reminders increased missed care, while digital engagement decreased it, highlighting the digital divide in radiology access.
Area of Science:
- Radiology and Imaging
- Health Services Research
- Quality Improvement Science
Background:
- Screening Mammography Missed Care Opportunity (SM-MCO) rates remain a challenge in ensuring timely cancer detection.
- Digital health interventions offer potential solutions to improve patient adherence to screening appointments.
- Quality Improvement (QI) frameworks provide structured approaches to developing and refining healthcare processes.
Purpose of the Study:
- To implement and evaluate a digital reminder program using a Quality and Safety Continuous Process Improvement approach.
- To assess the impact of Plan-Do-Study-Act (PDSA) cycles on Screening Mammography Missed Care Opportunity (SM-MCO) rates.
- To analyze the effect of digital engagement and specific interventions like SMS reminders and educational videos on SM-MCO rates.
Main Methods:
- A Quality Improvement study was conducted across two Federally Qualified Community Health Centers and a mobile mammography unit.
- The study employed Plan-Do-Study-Act (PDSA) cycles, including the implementation of a multilingual Short Messaging System (SMS) and an educational video.
- Statistical Process Control (SPC) p-charts and regression analyses were used to evaluate SM-MCO rates and digital engagement.
Main Results:
- The overall SM-MCO rate decreased from 29.2% pre-intervention to 26.9% post-intervention (P < .001).
- Appointments receiving SMS reminders had higher SM-MCO rates (35%) compared to those without (21.7%).
- Digital engagement was associated with lower SM-MCO rates (21.7% vs. 40.4%), and viewing the educational video further reduced this rate to 11.5%.
Conclusions:
- While the digital reminder program showed a modest overall reduction in SM-MCOs, SMS reminders paradoxically increased missed care.
- Digital engagement and educational video viewing significantly decreased SM-MCO rates, indicating their effectiveness.
- QI frameworks are crucial for iteratively refining digital strategies to bridge the digital divide and enhance access to radiology services.
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