Study: Inpatient Mammograms Can Reduce Screening Rate Disparities

New research suggests that a targeted intervention providing mammograms to hospitalized Medicaid patients can help them complete overdue breast cancer screenings, according to a press release.

Low-income people can face challenges when trying to complete cancer screenings, including mammograms, which can include lack of transportation and an inability to take time off of work. The pilot study investigated the feasibility of performing mammograms in women who were hospitalized and insured by Medicaid or both Medicaid and Medicare (dual-eligible patients).

“We designed the study to reach the patients who face significant barriers to completing their mammograms in the outpatient setting,” said first author Andrew S. Hwang, MD, MPH, in a press release. “National and local data show that Medicaid and dual-eligible patients have low rates of breast cancer screening. This targeted strategy has the potential to reduce disparities in cancer screening rates by addressing patients’ acute medical needs and their preventive care needs simultaneously.”

Investigators identified Medicaid and dual-eligible patients who were admitted to Massachusetts General Hospital’s (MGH) General Medicine service and were overdue for mammograms. Participants had primary care physicians affiliated with MGH who would be responsible for following up on abnormal mammogram results in collaboration with the MGH Breast Evaluation Team.

Of the 21 women who were identified as appropriate candidates for an inpatient mammogram, 17 women with an average age of 59 successfully completed the screening. The other 4 patients were discharged before the mammograms could be coordinated. Of the 17 women who completed their mammograms, 35% had never had a mammogram and the other women were overdue by an average of 4 years.

All of the mammograms were negative, except for 1 inconclusive result. For that patient, additional imaging evaluation was recommended to rule out cancer. Completing a mammogram did not increase the patients’ length of stay in the hospital.

In a press release, the investigators said they hope to build on the pilot study by offering inpatient mammograms to Medicaid and dual-eligible patients admitted to other areas of the hospital. They also hope to eventually deliver additional preventive care services, such as fecal immunochemical tests for colorectal cancer screening, to low-income hospitalized patients.

“The patients who participated in our pilot study faced significant psychosocial challenges to completing outpatient prevention tests,” Hwang said in the press release. “Attaining equitable health outcomes for all patients will require innovative solutions that lower the barriers to care by addressing patients’ psychosocial needs. In addition, as our health care system transitions from fee-for-service to value-based payment models, improving health outcomes among underserved patient populations will become increasingly important. Completing preventive screening tests, such as mammograms, during hospitalizations can be one way to help patients who might otherwise miss preventive care.”

REFERENCE

Inpatient mammograms can reduce disparities in breast cancer screening rates [news release]. EurekAlert; January 13, 2021. https://www.eurekalert.org/pub_releases/2021-01/mgh-imc011321.php. Accessed January 18, 2021.