Journal of General Internal Medicine

, Volume 15, Issue 5, pp 321–328

Differences in the quality of care for women with an abnormal mammogram or breast complaint

  • Jennifer S. Haas
  • E. Francis Cook
  • Ann Louise Puopolo
  • Helen R. Burstin
  • Troyen A. Brennan
Original Articles

Abstract

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.

DESIGN: Cross-sectional patient survey and medical record review.

SETTING: Ten general internal medicine practices in the Greater Boston area.

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

MEASUREMENTS AND MAIN 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.

Key words

quality of care mammography guidelines 

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Copyright information

© Society of General Internal Medicine 2000

Authors and Affiliations

  • Jennifer S. Haas
    • 1
    • 2
  • E. Francis Cook
    • 3
    • 4
  • Ann Louise Puopolo
    • 3
  • Helen R. Burstin
    • 3
  • Troyen A. Brennan
    • 3
  1. 1.the Division of General Internal MedicineSan Francisco General HospitalSan Francisco
  2. 2.the Institute for Health Policy StudiesUniversity of CaliforniaSan Francisco
  3. 3.Division of General MedicineBrigham and Women’s HospitalBoston
  4. 4.Department of EpidemiologyHarvard School of Public HealthBoston

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