{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T07:11:45Z","timestamp":1778051505922,"version":"3.51.4"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Examine the extent that community and organizational characteristics influence mammogram recall and biopsy rates in Appalachia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We collected facility survey and Medicare claims (2016\u20102018) data on 191 FDA\u2010registered breast imaging organizations serving 2.65 million women in 5 Appalachian states (KY, OH, PA, VA, and WV). Primary outcomes were recall rates and time to recall and biopsy. Generalized linear mixed\u2010effects models (GLMM) (patient level with facility random intercepts) and facility\u2010level structural equation models were used to evaluate multilevel predictors of recall, biopsy, and timeliness. Imaging center service areas (SAs) were constructed using Medicare claims for patient, facility, and community characteristics utilization patterns. Mammogram service capacity was measured using a published tool (BIOPSI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Rural centers had SAs with higher area deprivation index (ADI) scores, lower capacity despite possessing more machines per capita, and were less likely to offer 3D tomosynthesis (3DT). Recall (8%) and biopsy (\u223c22%) rates were similar by metropolitan status; however, rural centers were more likely to provide same\u2010day exams (\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a0.021). In GLMM, patient\u2010level predictors included younger age and nonuse of 3DT for recall; and higher ADI and use of 3DT for biopsy. Days to recall was lengthened with dual Medicaid insurance, 3DT, and screening by a stand\u2010alone facility; while days to biopsy was lengthened without the use of 3DT. Community\u2010level pathways were found for days to recall, with rural and smaller facilities achieving significantly fewer days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Characteristics of rural imaging centers influence efficiency through their resources and community contexts and should be considered in breast cancer screening outcomes research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70104","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T08:09:22Z","timestamp":1767859762000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient, facility, and community determinants of timely follow up after abnormal screening mammograms in Appalachia: A multilevel analysis"],"prefix":"10.1111","volume":"42","author":[{"given":"Roger T.","family":"Anderson","sequence":"first","affiliation":[{"name":"University of Virginia Comprehensive Cancer Center  Charlottesville Virginia USA"},{"name":"Department of Public Health Sciences University of Virginia School of Medicine  Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne M.","family":"Hillemeier","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Administration Pennsylvania State University  University Park Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer A.","family":"Harvey","sequence":"additional","affiliation":[{"name":"Department of Imaging Sciences University of Rochester Medical Center  Rochester New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian T.","family":"Camacho","sequence":"additional","affiliation":[{"name":"Department of Public 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