title: An assessment of the quality of mammography care at facilities treating medically vulnerable populations.
abstract: BACKGROUND
  Women in medically vulnerable populations, including racial and ethnic minorities, socioeconomically disadvantaged, and residents of rural areas, experience higher breast cancer mortality than do others. Whether mammography facilities that treat vulnerable women demonstrate lower quality of care than other facilities is unknown.
  
  
  OBJECTIVE
  To assess the quality of mammography women receive at facilities characterized as serving a high proportion of medically vulnerable populations.
  
  
  METHODS
  We prospectively collected self-reported breast cancer risk factor information, mammography interpretations, and cancer outcomes on 1,579,929 screening mammography examinations from 750,857 women, aged 40-80 years, attending any of 151 facilities in the Breast Cancer Surveillance Consortium between 1998 and 2004. To classify facilities as serving medically vulnerable populations, we used 4 criteria: educational attainment, racial/ethnic minority, household income, and rural/urban residence.
  
  
  RESULTS
  After adjustment for patient-level factors known to affect mammography accuracy, facilities serving vulnerable populations had significantly higher mammography specificity than did other facilities: ie, those serving a higher proportion of women who were minorities [odds ratio (OR): 1.32; 95% confidence interval (CI): 1.01-1.73], living in rural areas (1.45; 1.15-1.73), and with lower household income (1.33; 1.05-1.68). We observed no statistically significant differences between facilities in mammography sensitivity.
  
  
  CONCLUSIONS
  Facilities serving high proportions of vulnerable populations provide screening mammography with equal or better quality (as reflected in higher specificity with no corresponding decrease in sensitivity) than other facilities. Further research is needed to understand the mechanisms underlying these findings.
authors.affiliation: Department of Medicine, University of California, San Francisco, California 94143, USA. goldman1@medicine.ucsf.edu
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Goldman
authors.forename: Sebastien J-P A
authors.initials: SJ
authors.lastname: Haneuse
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Bonnie
authors.initials: B
authors.lastname: Yankaskas
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith-Bindman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D005260:Female; D006268:Health Facilities; D006801:Humans; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D012042:Registries; D015203:Reproducibility of Results; D014481:United States; D035862:Vulnerable Populations