DIAGNOSTIC DELAY IN BREAST DISEASE - A SYSTEM-ANALYSIS OF A PUBLIC URBAN HOSPITAL

Objective: To analyze the diagnostic process in 146 women referred to a breast clinic in an urban setting between January 1, 1994, and Decem ber 31, 1996. Design: We devised the ''diagnostic delay index (DDI),'' defined as the time between the medical system's awareness of a diagn ostic need and the completion of the diagnostic process. The time awai ting breast clinic consultation and the diagnostic events experienced- including clinic visits, imaging studies, and biopsies-were recorded. We stratified patients in 2 pathways (palpable masses and mammogram-id entified lesions) and by benign or malignant outcome. Results: Patient s in pathways 1 (n=85) and 2 (n=61) had a mean (+/-SD) DDI of 68.4 (+/ -46.9) days and 71.9 (+/-35.2) days, respectively. Patients in both pa thways who had a malignant outcome had a significantly lower DDI than those who had a benign outcome (47.5+/-30.9 days vs 78.6+/-42.6) (P<.0 01); this advantage was most pronounced in patients with palpable lump s. The average patient waited more than 3 weeks for both an initial cl inic consultation and operating room access. Quartile analysis of the DDI revealed statistically significant differences in clinic access ti me, number of visits, diagnostic events per visit, and operating room access time. Regression analysis demonstrates the relationship between DDI and measured process variables: DDI= -21.11+0.09 age+1.86 pathway -12.18 outcome+1.08 clinic access+11.91 visits+0.94 operating room ac cess (R-2=61.5%). Conclusions: In a public hospital, diagnostic delay is related to inadequate access to surgical consultation and a delay i n operating room access. Regression analysis demonstrates the relation ships between these components of system diagnostic delay and suggests strategies for reducing the DDI.