Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Saundra H Glover


Introduction:Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for increasing the offering of preventive care in breast cancer. This study examines the impact of EMR usage, and EMR generated provider reminders on physician ordering or providing of mammography screenings.

Methods:This study used survey data from the 2008-2010 National Ambulatory Medical Care Survey (NAMCS). Our sample included non-federal office-based physicians (n=2,785), and women age 45 and older who visited a physician from 2008-2010 (n=8,348). Chi-square analysis, ICD-9 coding and logistic regression analysis were performed to analyze the weighted data.

Results: Physician EMR use was not significantly associated with the odds that a woman would have a mammogram provided/ordered. However, significant findings of the study indicate that women on Medicare/Medicaid/SCHIP (OR=0.633, 95% CI 0.271-0.919) have significantly lower odds of receiving mammography screenings compared to women who have private insurance. In addition, women who visit obstetrics/gynecology (OR = 0.190, 95% CI 0.142-0.254) and internal medicine practices (OR = 0.553, 95% CI 0.393-0.778) have significantly lower odds of receiving a mammography, compared to women visiting general/family practices.

Conclusions: Women age 45 and older who have private are more likely to have a mammogram ordered or provided by a physician, compared to those women who are poor or without insurance. Based on our findings, women are having more general/family physicians providing them with routine care, and that these physicians are experiencing difficulty referring Medicare/Medicaid/SCHIP patients for specialty care. This may be due to patients being reluctant to pay a co-pay for mammography screenings, the short supply of specialists in the area, long waiting lists for specialists, specialists not accepting or limiting the number of patients who are covered by Medicare/Medicaid/SCHIP or self-pay, and low reimbursement rates. Further research is needed to uncover the true reasons as to why physicians are ordering/providing mammography screenings for women who are poor or on Medicare/Medicaid/SCHIP at lower rate than women who have private insurance.

In 2014, the Affordable Care Act is set to expand preventive services under the Medicaid program to cover recommended preventive services and immunizations. The referral process will be less difficult for physicians who refer self-pay and Medicare/Medicaid/SCHIP patients to specialists because patients will no longer have a co-pay for mammography screenings. In addition, we acknowledge that the HITECH statue authorizes incentive payments through Medicare and Medicaid to physicians and hospitals that use EMRs privately and securely to achieve specified improvements in care delivery. The incentive payments will help encourage physicians in all specialties to improve the ordering/providing of mammography screenings to women who are on Medicare/Medicaid/SCHIP in all races, ethnicities, and socioeconomic backgrounds.


© 2013, Charles Beverley, Jr.