Using the ACR Learning Network ImPower A3 to Increase Mammography Screening Percentages in Patient Populations Living in Areas with High Neighborhood Deprivation.

Purpose: There have been limited studies using structured quality improvement methods to address health disparities. Our purpose is to describe the integration of the ACR ImPower A3 template with our ongoing collaborations with population health to increase mammography screening percentages in patient populations living in high levels of neighborhood deprivation.

Methods/Materials: The A3 method is a quality improvement tool to identify problems, synthesize data, and propose solutions to achieve goals. ACR A3 template is outlined by a Global Aim with a SMART goal, Current State Analysis, Key Drivers, Interventions, and Sustained Planning. Quantitative data was derived from the EMR to determine if 50-74 year old women within our accountable care organization received a screening mammogram before and after interventions. Neighborhood deprivation was measured by the state deciles of the Area Deprivation Index. Chi square tests were used to evaluate differences in percentages. IRB approval was not required for quality improvement initiatives.

Results: SMART Goal – Increase percentage of patients (women aged 50-74 years) within the highest deciles of area deprivation index (6-10) undergoing screening within the last two years by 10% (66% to 76%) by December 2027, Current State – Decreased screening percentages in high neighborhood deprivation index deciles. Fishbone Diagram and Pareto Charts were used to identify Key Drivers: Improve access to screening mammograms, Improve communication, Reduce costs. Patient navigators were selected as intervention to comprehensively address key drivers and implement countermeasures. Screening percentages increased from 66% to 71% for women living in the highest 5 deciles of neighborhood deprivation by December 2023 (p = 0.029). No statistically significant changes occurred for women living in the lowest 5 deciles of neighborhood deprivation (76% to 77%, p = 0.080).

Conclusions: ImPower Learning Network A3 problem solving tools represent structured approaches to increase mammography screening percentages in underserved patient populations. This methodology can also be applied to improve health care outcomes across additional domains.