Timeliness of Abnormal Screening and Diagnostic Mammography Follow-up at Facilities Serving Vulnerable Women

Datos Bibliográficos

ID9103574
AutoresLee Goldman (University of California, San Francisco, autor de correspondencia), L Elizabeth Goldman, Rod Walker (0000-0002-8464-9805, Kaiser Permanente Washington Health Research Institute), Rebecca A Hubbard (0000-0003-0879-0994, Kaiser Permanente Washington Health Research Institute), Rebecca Hubbard, Karla Kerlikowske (0000-0001-8793-8779, University of California, San Francisco, autor de correspondencia)
Año2013
Volumen51
Número4
Páginas307-314
Fecha de publicación2013-04-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e318280f04c
PMID23358386
PMCIDPMC3966312
OpenAlexW2059790709
IdiomaEN
Citas recibidas5
Referencias citadas26

BACKGROUND: Whether timeliness of follow-up after abnormal mammography differs at facilities serving vulnerable populations, such as women with limited education or income, in rural areas, and racial/ethnic minorities is unknown. METHODS: We examined receipt of diagnostic evaluation after abnormal mammography using 1998-2006 Breast Cancer Surveillance Consortium-linked Medicare claims. We compared whether time to recommended breast imaging or biopsy depended on whether women attended facilities serving vulnerable populations. We characterized a facility by the proportion of mammograms performed on women with limited education or income, in rural areas, or racial/ethnic minorities. RESULTS: We analyzed 30,874 abnormal screening examinations recommended for follow-up imaging across 142 facilities and 10,049 abnormal diagnostic examinations recommended for biopsy across 114 facilities. Women at facilities serving populations with less education or more racial/ethnic minorities had lower rates of follow-up imaging (4%-5% difference, P<0.05), and women at facilities serving more rural and low-income populations had lower rates of biopsy (4%-5% difference, P<0.05). Women undergoing biopsy at facilities serving vulnerable populations had longer times until biopsy than those at facilities serving nonvulnerable populations (21.6 vs. 15.6 d; 95% confidence interval for mean difference 4.1-7.7). The proportion of women receiving recommended imaging within 11 months and biopsy within 3 months varied across facilities (interquartile range, 85.5%-96.5% for imaging and 79.4%-87.3% for biopsy). CONCLUSIONS: Among Medicare recipients, follow-up rates were slightly lower at facilities serving vulnerable populations, and among those women who returned for diagnostic evaluation, time to follow-up was slightly longer at facilities that served vulnerable population. Interventions should target variability in follow-up rates across facilities, and evaluate effectiveness particularly at facilities serving vulnerable populations

Biopsy · Breast cancer · Cancer · Confidence interval · Ethnic group · Interquartile range · Mammography · Radiology · Breast Lesions and Carcinomas · Demography · Digital Radiography and Breast Imaging · Global Cancer Incidence and Screening · Internal Medicine · Medicine