Dataset Information

Mammography facilities serving vulnerable women have longer follow-up times.

ABSTRACT:

Objective

To investigate mammography facilities' follow-up times, population vulnerability, system-based processes, and association with cancer stage at diagnosis.

Data sources

Prospectively collected from San Francisco Mammography Registry (SFMR) 2005-2011, California Cancer Registry 2005-2012, SFMR facility survey 2012.

Study design

We examined time to biopsy for 17 750 abnormal mammogram results (BI-RADS 4/5), categorizing eight facilities as short or long follow-up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced-stage (?IIb) cancer diagnosis by facility follow-up group.

Data extraction methods

Merged SFMR, Cancer Registry and facility survey data.

Principal findings

Facilities (N = 4) with short follow-up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow-up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow-up facilities. The long follow-up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow-up facility was associated with higher adjusted odds of advanced-stage cancer (OR 1.45; 95% CI 1.10-1.91).

Conclusions

Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow-up and cancer diagnosis stage.

SUBMITTER: Karliner LS

PROVIDER: S-EPMC6341204 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Mammography facilities serving vulnerable women have longer follow-up times.

Karliner Leah S LS Kaplan Celia C Livaudais-Toman Jennifer J Kerlikowske Karla K

Health services research 20181105

<h4>Objective</h4>To investigate mammography facilities' follow-up times, population vulnerability, system-based processes, and association with cancer stage at diagnosis.<h4>Data sources</h4>Prospectively collected from San Francisco Mammography Registry (SFMR) 2005-2011, California Cancer Registry 2005-2012, SFMR facility survey 2012.<h4>Study design</h4>We examined time to biopsy for 17 750 abnormal mammogram results (BI-RADS 4/5), categorizing eight facilities as short or long follow-up base ...[more]

PMID: 30394526

Similar Datasets

Project description: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.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.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).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.

Project description:BACKGROUND:Financial concerns are often cited by physicians as a barrier to administering routinely recommended vaccines to adults. The purpose of this study was to assess perceived payments and profit from administering recommended adult vaccines and vaccine purchasing practices among general internal medicine (GIM) and family medicine (FM) practices in the United States. METHODS:We conducted an interviewer-administered survey from January-June 2014 of practices stratified by specialty (FM or GIM), affiliation (standalone or???2 practice sites), and level of financial decision-making (independent or larger system level) in FM and GIM practices that responded to a previous survey on adult vaccine financing and provided contact information for follow-up. Practice personnel identified as knowledgeable about vaccine financing and billing responded to questions about payments relative to vaccine purchase price and payment for vaccine administration, perceived profit on vaccination, claim denial, and utilization of various purchasing strategies for private vaccine stocks. Survey items on payment and perceived profit were assessed for various public and private payer types. Descriptive statistics were calculated and responses compared by physician specialty, practice affiliation, and level of financial decision-making. RESULTS:Of 242 practices approached, 43% (n?=?104) completed the survey. Reported payment levels and perceived profit varied by payer type. Only for preferred provider organizations did a plurality of respondents report profiting on adult vaccination services. Over half of respondents reported losing money vaccinating adult Medicaid beneficiaries. One-quarter to one-third of respondents reported not knowing about Medicare Part D payment levels for vaccine purchase and vaccine administration, respectively. Few respondents reported negotiating with manufacturers or insurance plans on vaccine purchase prices or payments for vaccination. CONCLUSIONS:Practices vaccinating adults may benefit from education and technical assistance related to vaccine financing and billing and greater use of purchasing strategies to decrease upfront vaccine cost.

Dataset Information

Mammography facilities serving vulnerable women have longer follow-up times.

Objective

Data sources

Study design

Data extraction methods

Principal findings

Conclusions

Publications

Mammography facilities serving vulnerable women have longer follow-up times.

Similar Datasets

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