A Multi-Level Strategy for De-implementing Mammography Overuse Among Older Women

This project aims to advance methodological and theoretical approaches for developing, selecting, refining, and piloting a multilevel de-implementation strategy to reduce the overuse of screening mammography in women aged ≥75 years. Informed by an innovative participatory, stakeholder-driven innovation tournament and a discrete choice experiment, the research team identified, prioritized, and tailored a multilevel de-implementation strategy. The research team will conduct a cluster randomized controlled trial (at the provider level) to test the impact of the provider- and patient-level components of the multilevel strategy on screening mammography use, and secondarily, on provider referrals/orders for screening mammography. The organizational level components of the multilevel strategy will be implemented among all participants, not via random assignment.

Patient level criteria Inclusion criteria * English- or Spanish-speaking women based on preferred language in electronic health record * Aged 75 and older at the time of their scheduled primary care visit * Women who have a primary care visit scheduled within the next 2-4 weeks * Women who have not had a screening mammogram 6 months prior to their scheduled primary care visit but have had a screening mammogram 7-18 months prior to their scheduled primary care visit Exclusion Criteria * Women with a history of atypical ductal hyperplasia (ADH) or non-invasive or invasive breast cancer (assessed via ICD 10 code) * Women with dementia (assessed via ICD 10 code) * ICD codes to use across exclusion criteria: F01-F03, Z85.3, G30-G31, N60, C50, or D05 Provider level criteria Inclusion Criteria • Primary care clinicians attributed to the 2 intervention clinics that serve adult patients, including those ≥75 years Exclusion Criteria * Specialists * Primary care clinicians for patients \< 18 years old * Non-clinicians * Physician assistants