Quality of Mammography Facilities Serving Vulnerable Patients

PI Name: Goldman L
Title: Quality of Mammography Facilities Serving Vulnerable Patients

Background and overall topic: Medically vulnerable women such as those who live in rural areas, have low income, limited education, and racial and ethnic minorities are more likely to die from or be harmed by breast cancer. These disparities result, in part, from differences in access to efficient and effective diagnosis. Mammography, the mainstay of breast cancer diagnosis, decreases mortality, yet there remains significant variability in quality of mammography readings in different mammography facilities. Breast cancer advocates promote improving access to high quality care for all breast cancer patients, regardless of their race or ethnicity, income, education, or location of residence. However, there is little information as to whether the quality of mammography facilities where vulnerable women are screened and diagnosed with breast cancer differ from other facilities, or if differences exist, what path advocates should take to improve the quality of mammograms accessible to these women.

Hypothesis/questions addressed: Facilities serving vulnerable populations will have different qualities of screening and diagnostic mammograms than other facilities, and certain facility characteristics such as radiologist workforce shortages may account for differences in quality.

Objectives/aims: To evaluate the quality of care provided by facilities serving vulnerable women and assess the underlying mechanisms for any differences, we plan to evaluate the quality of screening and diagnostic mammograms comparing facilities serving vulnerable and non-vulnerable women and evaluate whether facilities factors mediate the relationship between quality and facility "vulnerability".

Methods and approaches: Using the seven Breast Cancer Surveillance Consortium (BCSC) registries between 1998 to 2004, we propose to use multivariate hierarchical regression at the individual mammography level clustered by facility to determine: (1) whether the sensitivity, specificity, recall rate of screening and diagnostic mammograms at facilities serving a high proportion of vulnerable women are better than at facilities serving fewer vulnerable women; (2) whether the wait time for screening and diagnostic mammography varies by facility vulnerability status; (3) whether facility level characteristics mediate the relationship between quality and vulnerability. We will use four criteria to classify facilities serving medically vulnerable populations: educational attainment, racial/ethnic minority, household income, and rural/urban residence.

Impact on breast cancer: This study will help policy makers and advocacy groups whether there are differences in the quality of care mammography facilities that provide care to vulnerable populations from other facilities and the underlying reasons for any found differences.