The Breast-Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects on screening in rural communities

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2023-10-03 DOI:10.1111/jrh.12798

Roger T. Anderson PhD, Marianne M. Hillemeier PhD, Fabian T. Camacho MS, Jennifer A. Harvey MD, Gloribel Bonilla MPH, George P. Batten PhD, Brenna Robinson M.Ed, Cara B. Safon MPH, Chris Louis PhD

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Abstract

Purpose

Develop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia.

Methods

Survey items describing 7 domains of imaging facility qualities were developed and tested in the Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. Medicare claims data (2016-2018) were obtained on catchment area mammogram services. Construct validity was examined from associations with facility affiliation, community characteristics, mammogram screening uptake, and market reach. Analyses were performed with t-tests and ANOVA.

Results

A total of 192 (of 377) sites completed the survey. Five factors were initially selected in exploratory factor analysis (FA) and refined in confirmatory FA: capacity, outreach & marketing, operational support, radiology review (NNFI = .94, GFI = 0.93), and diagnostic services (NNFI = 1.00, GFI = 0.99). Imaging capacity and diagnostic services were associated with screening uptake, with capacity strongly associated with catchment area demographic and economic characteristics. Imaging facilities in economically affluent versus poorer areas belong to larger health systems and have significantly more resources (P < .001). Facilities in economically distressed locations in Appalachia rely more heavily on outreach activities (P < .001). Higher facility capacity was significantly associated (P < .05) with larger catchment area size (median split: 48.5 vs 51.6), mammogram market share (47.4 vs 52.7), and screening uptake (47.6 vs 52.4).

Conclusions

A set of 18 items assessing breast imaging services and facility characteristics was obtained, representing policies and practices related to a facility's catchment area size, market share, and mammogram screening uptake.

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乳腺成像操作、实践和系统清单：一个检查乳房X光检查设施对农村社区筛查影响的框架。

目的：开发和测试阿巴拉契亚地区乳房X光检查设施资源、政策和实践的测量框架。方法：在肯塔基州、俄亥俄州、宾夕法尼亚州、弗吉尼亚州和西弗吉尼亚州的阿巴拉契亚州开发和测试了描述成像设施质量7个领域的调查项目。联邦医疗保险索赔数据（2016-2018年）是根据集水区乳房X光检查服务获得的。从设施隶属关系、社区特征、乳房X光检查接受率和市场覆盖率的相关性来检验结构有效性。采用t检验和方差分析进行分析。结果：共有192个（377个）站点完成了调查。最初在探索性因素分析（FA）中选择了五个因素，并在验证性因素分析中进行了改进：能力、外联和营销、运营支持、放射学审查（NNFI=0.94，GFI=0.93）和诊断服务（NNFI=1.00，GFI=0.099），容量与集水区的人口和经济特征密切相关。经济富裕地区和贫困地区的成像设施属于更大的卫生系统，拥有更多的资源（P<.001）。阿巴拉契亚经济困难地区的设施更依赖外展活动（P<0.001）。更高的设施容量与更大的集水区规模显著相关（P<.05）（中位数：48.5对51.6），乳房X光检查市场份额（47.4 vs 52.7）和筛查接受率（47.6 vs 52.4）。结论：获得了一组评估乳腺成像服务和设施特征的18个项目，代表了与设施的集水区规模、市场份额和乳房X光筛查接受率相关的政策和实践。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.