Affiliation:
1. University of Virginia Comprehensive Cancer Center Charlottesville Virginia USA
2. Department of Public Health Sciences University of Virginia School of Medicine Charlottesville Virginia USA
3. Department of Health Policy and Administration Pennsylvania State University University Park Pennsylvania USA
4. Department of Imaging Sciences University of Rochester Medical Center Rochester New York USA
5. Department of Health Law, Policy, and Management Boston University School of Public Health Boston Massachusetts USA
Abstract
AbstractPurposeDevelop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia.MethodsSurvey 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 witht‐tests and ANOVA.ResultsA 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).ConclusionsA 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.
Subject
Public Health, Environmental and Occupational Health