Differences in the quality of care for women with an abnormal mammogram or breast complaint.
OBJECTIVE
To examine factors associated with variation in the quality of care for women with 2 common breast problems: an abnormal mammogram or a clinical breast complaint.


METHODS
Cross-sectional patient survey and medical record review.


METHODS
Ten general internal medicine practices in the Greater Boston area.


METHODS
Women who had an abnormal radiographic result from a screening mammogram or underwent mammography for a clinical breast complaint (N = 579).


RESULTS
Three measures of the quality of care were used: (1) whether or not a woman received an evaluation in compliance with a clinical guideline; (2) the number of days until the appropriate resolution of this episode of breast care if any; and (3) a woman's overall satisfaction with her care. Sixty-nine percent of women received care consistent with the guideline. After adjustment, women over 50 years (odds ratio [OR], 1.58; 95% [CI], 1.06 to 2.36) and those with an abnormal mammogram (compared with a clinical breast complaint: OR, 1.75; 95% CI, 1.16 to 2.64) were more likely to receive recommended care and had a shorter time to resolution of their breast problem. Women with a managed care plan were also more likely to receive care in compliance with the guideline (OR, 1.72; 95% CI, 1.12 to 2.64) and have a more timely resolution. There were no differences in satisfaction by age or type of breast problem, but women with a managed care plan were less likely to rate their care as excellent (43% vs 53%, P <.05).


CONCLUSIONS
We found that a substantial proportion of women with a breast problem managed by generalists did not receive care consistent with a clinical guideline, particularly younger women with a clinical breast complaint and a normal or benign-appearing mammogram.
Haas
J S
JS
Division of General Internal Medicine, San Francisco General Hospital, and the Institute for Health Policy Studies, University of California, San Francisco, California 94143, USA. jhaas@itsa.ucsf.edu
Cook
E F
EF
Puopolo
A L
AL
Burstin
H R
HR
Brennan
T A
TA
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D008327:Mammography; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D013997:Time Factors