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Original Research |
1 Division of Breast Imaging, Department of Radiology, University of Cincinnati, The Barrett Center, 3rd Floor, 234 Goodman Ave., Cincinnati, OH 45219.
Received October 19, 2007;
accepted after revision February 4, 2008.
Address correspondence to M. C. Mahoney
(mahonemc{at}healthall.com).
Abstract
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MATERIALS AND METHODS. In this pilot study, we surveyed current and former mammography patients at our university hospital and another affiliated site. Three hundred three current mammography patients ("stayers") and 117 patients who no longer receive mammography services at these sites ("leavers") were interviewed by telephone between April and May 2003.
RESULTS. Stayers cited "doctor or hospital referral" (20%) and "quality of care" (19%) as reasons for having their mammography examinations at the university-based sites, with 77% "very satisfied" with the service and care they received. Fewer than 1% reported dissatisfaction. Stayers were also very satisfied with travel time from home (36%), convenience of parking (33%), and safety of the neighborhood (27%). Among leavers, 37% cited convenience to home or work as the reason for choosing their current mammography provider. Reasons for leaving the university-based sites included difficulty in scheduling appointments (15%) and current mammography provider mandated by their insurance provider (14%). Leavers expressed high levels of dissatisfaction with facility-related issues: travel time from home (26%), convenience of parking (26%), and safety of the surrounding neighborhood (19%).
CONCLUSION. Although both stayers and leavers reported satisfaction with overall quality of service and care received at the university-based locations, stayers gave higher marks than leavers.
Keywords: patient retention and attrition • screening mammography • university versus community sites
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Three hundred forty-one current mammography patients were contacted, with 303 agreeing to be interviewed and 38 declining. These "stayers" were patients who had undergone three consecutive screening mammographic examinations at our center in the previous 3 years. Thirty-five women were between 40 and 49 years old, 98 were between 50 and 59 years old, 88 were between 60 and 69 years old, 64 were between 70 and 79 years old, and 16 were 80 years or older. Eighty-two women were African-American, and 216 were white (with five not answering this question).
In addition, 150 former screening mammography patients were contacted. Thirty-three refused to participate in the study, and 117 were interviewed. These "leavers" were those patients who no longer receive screening mammography services through our center. Nineteen were between 40 and 49 years old, 42 were between 50 and 59 years old, 30 were between 60 and 69 years old, 20 were between 70 and 79 years old, and six were 80 years or older. Twelve were African-American, and 103 were white (with two not answering this question).
The patients interviewed were randomly selected from a computer database of patient records from the breast imaging center at our institution. A questionnaire, consisting of both open and closed questions, was developed by the Department of Health Policy Research at our institution. The surveys were conducted by telephone by trained and experienced interviewing staff members at our health policy research facility.
The current mammography patients, the stayers, were asked a series of 25 questions. Among others, they were asked to give the main reason they chose to have their most recent mammography examination at our dedicated breast center and to name the most positive and negative factors related to their most recent mammography visit. The patients were then asked specific closed-ended questions related to the location of our center, the process of making an appointment, the care and treatment they received, and their overall level of satisfaction with the mammography services provided. Their responses provided basis for an exploratory analysis of patient retention and patient attrition.
The former mammography patients, the leavers, were asked a similar series of 32 questions. This group was asked to give the main reasons for leaving our center and for choosing their current mammography provider. They were asked to name the most positive and negative factors related to their previous mammography visit to our center. The patients were then asked specific closed ended questions related to the locations of their current provider compared with our center; the process of making an appointment at both facilities, the care and treatment they received, and their overall level of satisfaction with the mammography services provided at their current mammography facility compared with our center.
Questions regarding the type of equipment available, such as digital mammography or computer-aided detection, were not asked. There were no questions directed to customer service issues such as the availability of daycare services or coordinating mammography appointments with other physician appointments or other hospital services.
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The patients' responses to specific closed-ended questions related to the location and appointment process at our center were as follows: 41% were very satisfied with the location of mammography services at the university-based center and its convenience to their home or office, and 53% reported they were very satisfied with the convenience of hours available for appointments.
The patients' responses to specific closed-ended questions related to the care and treatment they received and their overall level of satisfaction with the university-based center were as follows: 74% reported they were very satisfied with the respect shown to them by the staff, and 77% were very satisfied and 22% were satisfied with the overall service and treatment they received on their most recent mammography visit to our center.
As for the leavers, the most frequently cited reason for leaving the university-based center and choosing the current mammography provider was greater convenience to home and work, reported by 37% of the patients. Less frequently reported reasons were changes mandated by their insurance provider (14%) or referral to a new mammography provider by their physician (25%) (Table 3). Thirty-two percent of patients reported the friendliness of the staff as the most positive factor related to their previous mammography care at our center. Among the negative factors mentioned were long wait times to schedule an appointment (8%) (Table 4) and parking problems (6%) (Table 2).
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Leavers were asked to answer closed-ended questions pertaining to the location of mammography services at our university-based center. Patients reported being very dissatisfied or dissatisfied with the convenience of our center to their home or office in 29% of cases, very dissatisfied or dissatisfied with the convenience of parking in 26% of cases, and very dissatisfied or dissatisfied with the safety of the surrounding neighborhood in 19% of cases.
When asked about their satisfaction with the process of making an appointment at our center, 22% of the patients reported dissatisfaction with the ease of making an appointment at a time and date convenient to them. Very few patients reported any level of dissatisfaction with the quality of care and treatment they received at our center.
Patients reported some level of overall dissatisfaction with mammography services at our center in 19% of cases; but another 52% of former patients were very satisfied with the overall quality of mammography services. A higher percentage, 77% of patients, reported being very satisfied with their current mammography provider.
To summarize the data, although both leavers and stayers were satisfied with the overall quality of service and care of mammography services at the university-based center, stayers give higher marks than leavers. Stayers gave the highest satisfaction ratings regarding the respect and courtesy shown to them by the mammography staff at our center. Leavers were more negative than stayers in all aspects of location. Leavers report the highest levels of dissatisfaction with our center regarding convenience of the center to their home or office, convenience of parking, and concerns regarding safety of the surrounding neighborhood.
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There are a few limitations to this study. Originally, the study was designed to interview 300 stayers and 300 leavers, but the study was closed before this target was met in the leavers group. The study was prematurely closed by the hospital administrator once HIPAA was enforceable in 2003. However, we were able to use the data that had been collected to address deficiencies and formulate a retention plan that included the development of a free-standing patient-centered facility designed specifically for our screening mammography patients. This center will provide state-of-the-art digital screening mammography in a better location. Although still university-based, it is situated to offer greater convenience and better parking facilities. This should allow our facility to better compete with the suburban facilities for patients and physician referrals. Other studies have shown that women who underwent screening mammography were more positive and knowledgeable about the risk of breast cancer than women who have never been screened. The university-based practice is especially well-equipped to implement retention plans, which may include such brief interventions as a telephone questionnaire to remind patients of the importance of repeat screening [1, 6].
Another limitation of this study is the lack of statistical support in the evaluation of demographic information, such as level of education completed, ethnic distribution, and household income, to address possible disparities in access to preventive health care.
Finally, these results may also be limited to our particular urban setting, which includes poor mass transit and inner city problems. However, the data were compelling enough to result in the development of a new screening facility designed to address location issues raised by the patients who left our university facility. In addition, these pilot data will be used to design a new, more comprehensive study, a larger scale project that will allow us to construct models of patient decision making regarding mammography provider choice that could be applied to other geographic areas.
In conclusion, the primary reason for patients choosing another mammography facility is greater convenience to home or work. Expanding services to include off-site facilities within the community may improve retention in a screening mammography program and potentially ease the difficulty of scheduling convenient appointments. Referrals to other mammography facilities mandated by insurance providers or physician preference are unavoidable attrition factors. In the future, we hope to test whether models of decision making in our city setting can be applied to other urban settings.
The primary conclusion that we drew from this project, important to our practice, was that convenience of screening mammography facilities is a critical factor in retaining patients. As a result of this study, we have been able to bring about the creation of a free-standing patient-centered facility designed specifically for our screening mammography patients.
Acknowledgments
The author is indebted to Eric Rademacher from the Institute for Policy
Research, University of Cincinnati, for data management.
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