Leveraging a Quality and Safety Continuous Process Improvement Framework to Increase Breast Cancer Screening Access

To apply a Quality and Safety Continuous Process Improvement approach guided by Continuous Quality Improvement and Plan-Do-Study-Act (PDSA) cycles to develop, refine, and assess a digital reminder program's effect on Screening Mammography Missed Care Opportunity (SM-MCO) rates.

Study conducted at two Federally Qualified Community Health Centers and a mobile mammography unit. The pre-PDSA period was October 2020 to June 2023, and the post-PDSA period was July 2023 to January 2025. PDSA 1 launched a multilingual Short Messaging System (SMS) reminder across all sites. PDSA 2 standardized reminder process. PDSA 3 implemented a SM educational video. The primary outcome assessed the PDSA cycles' effect on SM-MCO rates. The secondary outcome assessed digital engagement. Quality improvement Statistical Process Control p-chart tracked appointment-level data. Univariate and logistic regression analyses assessed primary and secondary outcomes.

In all, 18,654 appointments were included in the analysis; average age was 56.8 (SD = 9.6 years), and 51.9% identified as Hispanic. The overall SM-MCO rate declined from 29.2% pre-PDSA to 26.9% post-PDSA (P < .001). Appointments with SMS had a 35% SM-MCO rate, compared with 21.7% without (P < .001). Appointments with digital engagement had an SM-MCO rate of 21.7% compared with 40.4% without engagement (P < .001). Appointments that received and viewed the video had an SM-MCO rate of 11.5% compared with 26.9% without it (P < .001).

Although a modest decrease in overall SM-MCOs rate was observed, SM-MCO rates were higher among appointments that received SMS reminders but lower among appointments with digital engagement, underscoring the digital divide complexity. Quality Improvement frameworks can continuously monitor and refine digital strategies to increase access to radiology.