In May, the American Cancer Society released updated breast cancer screening guidelines, which emphasize educating women -- especially those at increased risk for breast cancer -- about the benefits and limits of mammography and other screening methods.

"Education can help patients better understand their risk factors and the need to follow through on tests," said James Liljestrand, M.D., MPH, quality improvement advisor at MassPRO, a health care quality improvement organization for Massachusetts, and member of the former MMS Task Force on Quality Improvement in Breast Cancer Care. "The Cancer Society is a good resource for patients."

Implementing Office Systems
In order to increase opportunities for the early breast cancer detection and treatment, Maureen Mondor, vice president of risk management at ProMutual Group, a medical malpractice insurer based in Boston, suggests that physicians implement office systems for communication, follow-up and documentation. Some tools may include brochures to tell patients how and when they can expect test results. Computer programs can also assist by prompting staff to set up patient appointments for tests and notify them of results, as well as document follow-up efforts.

Acton Medical Associates, P.C., a primary care practice with 22 physicians in three locations, developed an Access-based system to track preventative and follow-up tests and provide reminders if tests are not performed or reviewed.

"There was an initial time investment to develop the system, but now minimal resources are required to maintain it," said Bob Renga, the chief operating officer at Acton Medical Associates. Physicians provide the criteria and time limits to be programmed into the system. Renga said that nurses or office staff can then handle the data entry, reminders to patients and follow-ups with the labs.

Realizing Results
"It's a win-win situation all around," Renga said. "The patient receives quality care when routine preventative tests are performed. The chances of early detection and treatment are improved, which is good for the patient, physician and possibly the insurer." He adds that all major insurers provide bonuses for collecting quality of care or performance data, also known as Health Plan Employer Data and Information Set (HEDIS) measures, including mammogram rates.

While Acton Medical Associates developed their own program, physician practices can also take advantage of existing software. Two free software programs, currently available are SECAT, offered by the Illinois Foundation for Quality Health Care, and CDMS, developed by the Montain-Pacific Quality Health Foundation.

In addition, MassPRO, in collaboration with the Centers for Medicare and Medicaid Services and the American Medical Association, is piloting a program to help physicians implement quality improvement initiatives for breast cancer, diabetes and immunization. MassPRO is recruiting primary care physicians for the free program, which will provide assistance and free software, as well as continuing medical education credit. For more information, visit www.masspro.org or call Dr. Liljestrand at (781) 419-2785.

- Robyn Alie