Feasibility Of A Regional Outreach Program To Increase Abdominal Aortic Aneurysm (aaa) Screening Exams
Matthew W. Mell, MD, MS, Avni Suri, BS, Ashley K. Truong, BS, Angela M. Aguirre, BS, Janet P. Wells, RN, MS.
University of California at Davis, Sacramento, CA, USA.
OBJECTIVES: AAA screening based on Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act remains under-utilized. We sought to determine the feasibility of an institutional effort to increase AAA screening for rural and urban patients who receive primary care outside of our network of care.
METHODS: Eligible patients for AAA screening based on the SAAAVE Act were identified through the EMR. Patients were included if they had received care in our institution within three years, and were without an in-network PCP. Demographics, rural-urban residence, previous imaging and distance from our institution were collected. Those without imaging were offered AAA screening by mail and telephone. Results of the screening invitation were recorded.
RESULTS: The cohort comprised 390 (199 urban and 191 rural) patients aged 67 ± 1 year. Rural patients were more likely to be white (85% vs. 67%, p<.001), less likely to have chronic kidney disease (12.6% vs. 20.6%, p=.03) or diabetes (20.4% vs. 31.2%; p=.016), and resided significantly farther from our institution than urban patients (86 ± 51 vs. 40 ± 42 miles; p<.001). Prior imaging had been performed in 40.5%, and was more frequent for urban patients (46.0% vs. 34.7%, p=.02). Only 6.4% of prior imaging was performed specifically for AAA screening. Telephone (86.4%) was more effective than mail (13.6%) to achieve patient contact. AAA screening invitation was accepted by 63.6% with a trend for increased acceptance by urban patients (75.9% vs. 54.1%; p=.068). The majority of patients (76.2%) favored to have screening performed at our institution, a preference that was associated with shorter travel distances (46 ± 46 vs. 122 ± 55 miles; p=.03). In all, AAA were identified in 3.8% of studies.
CONCLUSIONS: Prior aortic imaging was performed in a minority of eligible patients receiving primary care outside of our institution and was generally not done for the purpose of AAA screening. Rural at-risk patients were less likely to have prior imaging, and were less likely to agree to screening. Identification of AAA remains consistent with historical studies, highlighting the importance of ongoing efforts to optimize AAA screening for at-risk patients.
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