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You oversee a community-based health alliance that has received funding to improve mammography rates for women in your community. The funding source is particularly interested in addressing the needs of women who are Medicare beneficiaries. They have provided you with a reference document of intervention strategies to increase mammography rates, produced by the Center for Disease Control and Prevention. You consult the National Committee for Quality Assurance website to get a general idea of the quality measure and to see the trends for women receiving a biennial (once every two years) mammogram.

After reviewing the NCQA website, you realize that the mammography measure is defined for women between the ages of 50 and 74. Medicare beneficiaries are primarily those 65 years of age and older. However, in the 1970s, Medicare extended coverage to include those who have end-stage renal disease (kidney failure) and those who have certain disabilities (the most common type of disability in this population is mental illness). Given the characteristics of the target population, you realize that the mammography campaign has substantial limitations. On the upside, the funding source has access to beneficiary-level data from CMS. After careful consideration, you have identified two interventions that the alliance may pursue:

• A community-wide campaign consisting of placing educational posters in high-traffic areas
• A series of educational workshops targeting women in the community who meet the mammography measure’s eligibility criteria

You only have resources to select one of the interventions and have been given a timeline for completion of 18 months. Prepare a brief report to the alliance board with a recommendation for one of the interventions.

Begin your report with some background. From your review of the CDC document, explain the purpose of the mammography measure in broad terms, drawing from your understanding of the mammography measure and the barriers confronting providers when trying to improve mammography rates.

For both of the interventions, address the following:

1. Describe at least one methodological issue related to each intervention that may arise when dealing with the target population.
2. Describe at least one methodological issue related to each intervention that may arise when attempting to assign participants to a study group or a control group.
3. Describe at least one methodological issue related to each intervention that may arise when attempting to assess the outcomes of the experiment (e.g., the study group versus the control group).

Finally, conclude with a recommendation. Based on your evaluation of the interventions, select the intervention that you feel presents the fewest methodological concerns and which can be most effectively analyzed. Provide a rationale for your selection.

Your report should be written in essay style using vocabulary and grammar consistent with your standing as a healthcare professional.