Document Detail


Timeliness of abnormal screening and diagnostic mammography follow-up at facilities serving vulnerable women.
MedLine Citation:
PMID:  23358386     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
L Elizabeth Goldman; Rod Walker; Rebecca Hubbard; Karla Kerlikowske;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Medical care     Volume:  51     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-13     Completed Date:  2013-05-02     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  307-14     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Breast Neoplasms / diagnosis*,  therapy
Delayed Diagnosis / statistics & numerical data*
Ethnic Groups / statistics & numerical data
Female
Follow-Up Studies
Health Services Accessibility / statistics & numerical data*
Humans
Incidence
Mammography / statistics & numerical data*
Medicare / statistics & numerical data
Practice Guidelines as Topic
Retrospective Studies
Rural Population / statistics & numerical data
Socioeconomic Factors
Time Factors
United States / epidemiology
Vulnerable Populations / statistics & numerical data*
Grant Support
ID/Acronym/Agency:
1K08 HS018090-01/HS/AHRQ HHS; HHSN261201100031C//PHS HHS; KL2 RR024130/RR/NCRR NIH HHS; KL2 RR024130/RR/NCRR NIH HHS; U01 CA086076/CA/NCI NIH HHS; U01CA63731/CA/NCI NIH HHS; U01CA63736/CA/NCI NIH HHS; U01CA63740/CA/NCI NIH HHS; U01CA69976/CA/NCI NIH HHS; U01CA70013/CA/NCI NIH HHS; U01CA70040/CA/NCI NIH HHS; U01CA86076/CA/NCI NIH HHS; U01CA86082/CA/NCI NIH HHS
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