Use of a Paper Checklist to Increase Clinician Adherence to Mammography Screening Guidelines

Abstract

Objective: To increase clinician adherence to mammography screening guidelines.

Design: Quality improvement initiative.

Setting/local problem: At a nurse practitioner-led primary care practice, a chart audit of adherence to American Cancer Society mammography screening guidelines indicated a 12% adherence rate for clinicians writing mammography orders.

Participants: Nurse practitioners providing care to women ages 40 years and older.

Intervention/measurements: The intervention was a screening checklist that was completed by the woman at registration and given to the clinician during the examination. The pre- and postintervention measurement was the percentage of mammogram orders. A Fisher exact test was used to examine changes from pre- to postintervention rates of adherence.

Results: After the intervention, the percentage of women for whom a mammogram was recommended and ordered was 69.6%, compared to 12% from the original chart audit. This change was statistically significant (p = .01).

Conclusion: Clinicians must find efficient approaches to improve processes within their practice settings to ensure that preventive care recommendations are made during visits. Although the screening checklist was deemed useful, improvement in adherence rates is still needed, and a paperless system should be initiated.

Keywords: adherence; breast cancer; clinician; mammogram; mammography; nurse practitioner; primary care provider; quality improvement; screening.