Skip Navigation LinksHome > April 2013 - Volume 51 - Issue 4 > Timeliness of Abnormal Screening and Diagnostic Mammography...
Medical Care:
doi: 10.1097/MLR.0b013e318280f04c
Original Articles

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

Goldman, L. Elizabeth MD, MCR*; Walker, Rod MS; Hubbard, Rebecca PhD; Kerlikowske, Karla MD*; for the Breast Cancer Surveillance Consortium

Supplemental Author Material
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Abstract

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.

© 2013 Lippincott Williams & Wilkins, Inc.

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