Judith K. Barr

Understanding barriers to participation in mammography by women with disabilities.

Purpose. The study purpose was to identify barriers to mammography screening among women with different disabilities and to suggest interventions to address barriers. Methods. Forty-two women with self-reported disabilities, ages 40 to 69 years participated. They resided in 24 Connecticut towns, and most had a prior mammogram. Data were collected through six disability-specific focus groups from women with sensory, physical, psychiatric, and cognitive/intellectual impairments. Facilitator-conducted groups used a semistructured guide. Qualitative analysis applied an iterative coding process to generate themes and categories. Results. We identified four themes (i.e., access, beliefs, social support, and comfort/accommodations) and nine subthemes that characterized barriers. In all focus groups, women mentioned physical access and physical comfort/accommodations as types of barriers. Other major subthemes were communication and professional support. Women also described mammography facilitators. Conclusion. Despite frequent use of health care and personal strategies to facilitate mammography screening, women with disabilities reported barriers to getting mammograms. Findings suggest a multifaceted approach to address these barriers.

Supporting the Elderly: Workplace Programs for Employed Caregivers

An aging population and extended longevity are increasing the number of older people needing informal and family support. At the same time, women, the traditional caregivers, have entered the work force in record numbers. Consequently, concerns about how to care for dependent family members have become workplace issues. In response to the needs of employees who care for family members, employers have produced an array of policies, benefits, and programs, including flexible work schedules and information and referral services. Although these programs are a valuable complement to community services and government initiatives, relatively few employers have recognized the potential effects of caregiving on absenteeism, productivity, and turnover; even fewer have responded with workplace programs directed to the needs of their caregiving employees. To fill the gap, the government is considering mandating employee benefits, such as leave time for family illness. Community services are increasingly being directed to the needs of older people and their caregivers.

Lessons Learned from Performance Feedback by a Quality Improvement Organization

&NA; Performance feedback is a common quality improvement (QI) intervention strategy in the outpatient setting. This article describes the use by one quality improvement organization (QIO) of performance feedback to primary‐care physicians with claims‐based measures relating to diabetes, adult vaccinations, and mammography screening. Feedback from the physicians identified themes relating to data accuracy, methodology of the feedback reports, reasons for low performance rates, and suggestions on how the QIO could improve its intervention strategy. The article highlights the value of collecting and analyzing formative data on the process and offers specific recommendations to other QI professionals contemplating the use of claims data for performance feedback.

A Comprehensive Evaluation of a Diabetes Quality Improvement Project in Privately Owned Primary Care Practices That Serve Minority Patients

The authors conducted a diabetes quality improvement project in 5 privately owned primary care practices serving at least 25% minority patients. Interventions included group-specific and practice-specific training on an electronic patient registry, cultural competency practices and tools, and selected quality improvement strategies. The authors conducted a comprehensive evaluation involving quantitative and qualitative data to assess project impact. Although overall clinical performance did not improve over the 14- to 20-month project time frame, other practice structural characteristics and processes did show improvement: successful implementation of the registry and clinician reminders in all practices, institution of team care and patient reminders in 4 practices, and collection of patient race/ethnicity data in 4 practices. These results highlight the difficulty of bringing about clinical improvement in this subset of practices and also the importance of conducting comprehensive evaluations to fully understand and interpret multicomponent quality improvement projects.

Challenges in Recruiting Minority-Serving Private Practice Primary Care Physicians to a Quality Improvement Project

The objectives of this study were the following: (1) describe one organization’s experience with recruiting minority-serving private practice primary care physicians to an ambulatory quality improvement (QI) project; (2) compare and contrast physicians who agreed to participate with those who declined; and (3) list incentives and barriers to participation. The authors identified eligible physicians by analyzing Medicare Part B claims data, a publicly available physician database, and office staff responses to telephone inquiries. The recruitment team had difficulty identifying, contacting, and recruiting eligible physicians. Solo practitioners and physicians who had lower scores on certain quality measures were more likely to participate. Barriers to participation were similar in all practices and included concerns about extra work, difficulty of change, and impact on office work flow. Commonly used incentives were offered but were not universally embraced. Additional work is required to refine the process of physician recruitment and to find more compelling incentives for QI.

Methodological issues in public reporting of patient perspectives on hospital quality.

BACKGROUND Increasing attention is being focused on public reporting of patient satisfaction and experience with hospital care, both nationally and at the state level. Comparative reports on hospital patient satisfaction use a standard survey, but little is known about underlying methodological approaches for reporting these quality measures. METHODS Literature, Web sites, and key informants were used to identify nine public reports. In-depth reviews were conducted to determine approaches to collecting, analyzing, and publicly reporting comparative data. Data were grouped into four analytic categories: survey, sampling, computation of scores, and reporting of scores. RESULTS The reports were similar in response rates and sampling procedures but differed in the number of hospitals included, the survey instrument, and survey procedure. The reports varied considerably in the techniques for computing hospital scores and decisions about reporting scores. CONCLUSIONS Reports from nine locales illustrate the decision making necessary to produce comparative reports on hospital patient satisfaction. Differences stem from decisions about the survey instrument and statistical decisions about how to interpret and report data. These issues should be clearly delineated as part of any public reporting process.

Understanding patterns of change over time to improve mammography rates.

&NA; This retrospective cohort study determined trends and patterns of mammography rates during 5 years (1997–2001) among female Medicare beneficiaries ages 50 years and older in Connecticut to better understand changes in rates over time and to plan future interventions. Time series analysis and hierarchical longitudinal logistic regression were used to assess changes over time. Mammography rates increased significantly during the 5‐year period (p < .001). A cyclical pattern was observed for all age groups and counties, with dips and peaks in the spring and fall each year (average increase 8% per year), consistent with concentrated intervention activity at those times.