Five-year follow-up of a nurse-initiated intervention to improve mammography recommendation

In a previous study we found immediate effectiveness of a nurse-initiated intervention on improving mammography recommendation rates in a family practice residency program. To determine the long-term effectiveness of this ongoing intervention, we performed a chart audit study on two different groups of charts 5 years after the institution of the intervention.

Chart audits for mammogram recommendation and completion rates were conducted on an original cohort group of women aged 40 years and older (n = 91) and a new 5-year postintervention group of women aged 53 years and older (n = 189). Preintervention, postintervention, and 5-year postintervention rates were compared within the cohort group. Rates of the new 5-year postintervention group were compared with rates of women 50 years and older from the original preintervention group and postintervention group.

For the original cohort group the improvement in "mammograms done at least once in the past 3 years" was maintained 5 years later, and there was a statistically significant increased rate from the postintervention to 5 years later (73.9 percent versus 86.8 percent, P < 0.02) for "mammograms done or recommended at least once in the past 3 years." This improvement was also noted for the new 5-year postintervention group when their rates were compared with the preintervention and postintervention group rates. For "mammograms done at least once in the past 3 years," the rates were 34.2 percent, 45.5 percent, and 64 percent, respectively. For "mammograms done or recommended at least once in the past 3 years," the rates were 42.6 percent, 72.7 percent, and 90.0 percent, respectively. In a separate analysis, annual mammogram rates in the new 5-year postintervention group for the 3 years preceding this study were 44.8 percent (1990), 36.5 percent (1991), and 36.5 percent (1992). Eleven percent of women had a mammogram done in each of the 3 consecutive years.

An ongoing nurse-initiated intervention is a feasible method of improving and maintaining mammogram recommendation and completion rates. Further studies of interventions to improve the rate at which eligible women get consecutive annual mammograms are needed.