Evaluation of Proscriptive Health Care Policy Implementation in Screening Mammography

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Abstract
To evaluate the potential effect of proscriptive health care policies directed toward improving screening mammogram interpretation in the United States. Percentiles of accuracy based on a random sample of 110 U.S. radiologists were used to examine the number of radiologists who would need to be restricted from providing mammographic interpretation to increase median accuracy from 66% to 67%, 71%, and 76%. In addition, reading volume data recorded for the sampled readers were used to project the percentage reduction in service volume (mammograms per year) that would result from restriction. Characteristics of participating radiologists were compared with those of nonparticipating radiologists by using chi2 testing and analysis of variance to assess the external validity of the results. To increase median accuracy by 1% (from 66% to 67%) would require prohibiting about 2,200 U.S. radiologists (ie, the 11% in the lowest quantile for accuracy) from performing mammographic interpretation and would result in a reduction of yearly service volume of approximately 10%. An increase in median accuracy of 5% (to 71%) would require prohibiting about 6,000 U.S. radiologists (ie, 30%) from performing this service, with an accompanying volume reduction of 25%. An increase in median accuracy of 10% (to 77%) would require prohibiting about 11,400 practicing U.S. radiologists (ie, 57%) from performing this service and would diminish the national service capacity by 50%. These data show that implementation of proscriptive health care policies based on accuracy would diminish the service capacity of screening mammography in the United States.