title: Influence of physician, patient, and health care system characteristics on the use of outpatient mastectomy.
abstract: BACKGROUND
  Breast cancer is the 2nd leading cause of cancer deaths among women in the United States. Breast cancer surgeries can be performed on either an inpatient or ambulatory basis. This systematic review of literature on outpatient mastectomy examines what is known about the factors that influence the use of this procedure, existing public policies, and strategies to promote the appropriate use of outpatient mastectomy.
  
  
  METHODS
  Factors associated with the utilization of outpatient mastectomy were categorized and discussed under the following headings: "patient level," "physician level," and "system level."
  
  
  RESULTS
  Potential contributing factors to the use of outpatient mastectomy at the patient level were race, educational level, comorbid conditions, cancer stage, and health insurance. Contributing factors at the provider level were demographics, surgeon specialty, and whether physician is an American or international graduate. The associated factors at the system level were state policy and legislation and hospital characteristics.
  
  
  CONCLUSIONS
  The evidence in the research literature suggests that the use of outpatient mastectomy is a function of interactions between patient and physician characteristics, managed care influences, and the state policies and laws.
authors.affiliation: Department of Health Services Research, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223-0001, USA. Electronic address: sshahbaz@uncc.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Shahbazi
authors.affiliation: School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, USA.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Woods
mesh_terms: D000556:Ambulatory Surgical Procedures; D001943:Breast Neoplasms / Q000601:surgery*; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008408:Mastectomy; D009367:Neoplasm Staging; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013219:State Government; D014481:United States
keywords: Outpatient mastectomy; Patient-level; Provider-level; Public policies; System-level characteristics