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

Sponsor: Columbia University • ClinicalTrials.gov ID: NCT07511621

Registry updated: 2026-09-25

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Description

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.

Interventions

Enhanced Usual Care (EUC) (Other)
EUC entails the organizational level components of the multilevel de-implementation strategy. These organizational components have been implemented within the overarching New York City healthcare system where the 2 clinics receiving the provider and patient components are located. The organizational level components are: 1) Grand Rounds Education: providers and clinic leadership received Grand Rounds education on screening mammography overuse among older women, and 2) Task Force: a multidisciplinary task force (e.g., radiologists, breast oncologists, primary care providers, clinic leadership) have been collaborating with the research team to build consensus around guidelines for clinical practice and revisions to the screening mammography results and reminder letters sent to patients.
Multilevel De-Implementation Strategy (Behavioral)
This multilevel de-implementation strategy includes the organizational level components that comprise EUC (described above) as well as provider and patient level components. At the provider level, the research team will disseminate educational newsletters including the latest guidelines, information, and resources on screening mammography for older women. At the patient level, the research team will disseminate a brief brochure titled the 'Rethink Resource' in which patients are activated and encouraged to speak with their providers about whether continuing to get mammograms is best for them given current guidelines.

Eligibility criteria

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

Conditions

Mammography Medical Overuse Evidence-based Practice Older Adults

Locations

Columbia University Irving Medical Center — New York, New York, United States

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Official Source

Data sourced from ClinicalTrials.gov, a service of the U.S. National Institutes of Health.

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