Mammography Screening in a Large Health System Following the U.S. Preventive Services Task Force Recommendations and the Affordable Care Act.
Mammography Screening in a Large Health System Following the U.S. Preventive Services Task Force Recommendations and the Affordable Care Act.
复制标题
DOI：
10.1371/journal.pone.0131903
复制
发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Grunkemeier G
中科院分区：
文献类型：
--
作者：
Nelson HD;Weerasinghe R;Wang L;Grunkemeier G
美国预防服务工作组于2009年发布了乳房X线摄影筛查的实践建议，此后不久，根据《患者保护和平价医疗法》扩大了保险范围，但这些变化对美国筛查实践的影响尚不清楚。为了确定乳房X线摄影筛查的变化及其与新实践建议和平价医疗法案的关联，我们检查了2008年1月1日至2012年12月31日美国西北部大型社区卫生系统中249，803例筛查乳房X线摄影的患者水平数据。通过时间序列数据方法的干预分析确定关联。在接受筛查的妇女中，64%的年龄在50-74岁之间; 84%的人自称是白色种族; 62%的人有商业保险; 70%的人在大都市地区的设施中就诊。实践建议与年龄<40岁的女性筛查量减少有关（-37.4次乳房X线检查/月; -39.4%变化; P<0.001），40-49（-106.0次乳房X线检查/月; -11.2%变化; P<0.001）和≥75（-54.7次乳房X线检查/月; -10.0%变化; P<0.001），但50-74岁的女性则没有。《平价医疗法案》的实施与50-74岁女性的筛查增加有关（每月+184.3次乳房X光检查;变化+7.2%; P=0.001），但与<40岁或≥75岁的女性无关; 40-49岁女性的筛查增加具有边缘统计学意义（每月+56.9次乳房X光检查;变化+6%; P=0.06）。实践建议也与商业保险妇女的筛查减少有关，而《平价医疗法案》与医疗保险、医疗补助或其他非商业支付来源的妇女的筛查增加有关。在大型社区卫生系统中，年龄<50岁和≥75岁的女性的乳房X线检查筛查量下降与新的美国预防服务工作组实践建议相关，而根据《平价医疗法案》的保险覆盖范围变化与50-74岁女性的筛查量增加相关。
Practice recommendations for mammography screening were issued by the U.S. Preventive Services Task Force in 2009 and expansion of insurance coverage was provided under the Patient Protection and Affordable Care Act soon thereafter, yet the influence of these changes on screening practices in the United States is not known. To determine changes in mammography screening and their associations with new practice recommendations and the Affordable Care Act, we examined patient-level data from 249,803 screening mammograms from January 1, 2008 through December 31, 2012 in a large community-based health system in the northwestern United States. Associations were determined by an intervention analysis of time-series data method. Among women screened, 64% were age 50-74 years; 84% self-identified as white race; 62% had commercial insurance; and 70% were seen in facilities located in metropolitan areas. Practice recommendations were associated with decreased screening volumes among women age <40 (-37.4 mammograms/month; -39.4% change; P<0.001), 40-49 (-106.0 mammograms/month; -11.2% change; P<0.001), and ≥75 (-54.7 mammograms/month; -10.0% change; P<0.001), but not women age 50-74. Implementation of the Affordable Care Act was associated with increased screening among women age 50-74 (+184.3 mammograms/month; +7.2% change; P=0.001), but not women <40 or ≥75; increases for age 40-49 were of borderline statistical significance (+56.9 mammograms/month; +6% change; P=0.06). Practice recommendations were also associated with decreased screening for women with commercial insurance, while the Affordable Care Act was associated with increased screening for women with Medicare, Medicaid, or other noncommercial sources of payment. Mammography screening volumes in a large community health system decreased among women age <50 and ≥75 in association with new U.S. Preventive Services Task Force practice recommendations, while insurance coverage changes under the Affordable Care Act were associated with increased screening volumes among women age 50-74.
登录
查看更多内容
DOI：
10.7326/0003-4819-137-5_part_1-200209030-00011
发表时间：
2002-09-03
影响因子：
39.2
作者：
Berg, AO;Allan, JD;Woolf, SH
通讯作者：
Woolf, SH
影响因子：
5.1
作者：
Howard, David H.;Adams, E. Kathleen
通讯作者：
Adams, E. Kathleen
影响因子：
39.2
作者：
Calonge, Ned;Petitti, Diana B.;Wilt, Timothy
通讯作者：
Wilt, Timothy
影响因子：
45.3
作者：
Wharam, J. Frank;Landon, Bruce;Ross-Degnan, Dennis
通讯作者：
Ross-Degnan, Dennis
影响因子：
6.2
作者：
Carney, PA;Goodrich, ME;Titus-Ernstoff, L
通讯作者：
Titus-Ernstoff, L