105 - Elevating the voice of women using an equitable transdisciplinary approach to define and measure mammographic quality

Abstract Information: Breast cancer disparities in mortality rates and stage of diagnosis continue to persist in Wisconsin. The Mammographic Quality Initiative (MQI) examines the mammographic process to understand factors that contribute to quality and create a shared measurement system to monitor and improve. While health care quality and shared measurement are not new, our use of a transdisciplinary approach with a justice lens to define what factors are measured and how they are applied to shape mammographic quality is novel. This demonstration highlights the potential contributions to health care quality measurement made by centering the voice of patients in discussions of how to define and measure mammographic quality. MQI is a project of the Community and Cancer Science Network (CCSN), a statewide effort, that brings together teams of academic medicine and non-academic medicine partners to develop new research and action agendas to address disparities. MQI uses a model of transdisciplinary engagement to eliminate power differentials between academic medicine, community clinicians, health systems and members of the community to address breast cancer disparities. A leadership team with the support of a developmental evaluator leads this project and convenes regional learning collaboratives (RLCs) to examine quality and ways to improve. In mammography, there are pervasive mental models about patients that have resulted in definitions and measures of quality that do not consider the whole process or whole person. The absence of quality data leads literally and figuratively to women “checking out” of the process—and in many cases, furthering the disparities we see in breast cancer screening and follow-up. Our approach employs multiple learning methods to challenge long-held assumptions of what quality mammography is based largely on the power one holds in the process. Learnings highlight that traditional measures based on provider’s perspectives does not present a complete definition of mammographic quality. While providers and patients agree that mammography is a highly technical process, simultaneously, it is a highly intimate one. Our current quality measures do not balance that equation. As such, we only understand a portion of what makes the experience “quality” and why disparities in breast cancer outcomes persist. The perspectives of the cis-gendered women in this project lead us to the conclusion that perhaps we misunderstood disparities in mammographic quality– that inequity in the mammography process isn’t just improving a handful of benchmarks, but instead, about addressing the role and positioning of gender in health care and society at large. In this demonstration, we will walk attendees through the learning tools we found most helpful in gathering insights and in working with the leadership team and RLCs to begin to shift metal models around the mammography process. We will also share what we are hearing from women about their mammogram and how important it has been to them to finally be asked to share their thoughts and ideas with someone about this experience. The evaluation tools applied throughout this project hold the leadership team and RLC accountable to our equity values and approach in a way that traditional evaluation could not.