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

OBJECTIVE: To examine factors associated with variation in the quality of c are for women with 2 common breast problems: an abnormal mammogram or a cli nical 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 screenin g mammogram or underwent mammography for a clinical breast complaint (N = 5 79). MEASUREMENTS AND MAIN RESULTS: Three measures of the quality of care were u sed: (1) whether or not a woman received an evaluation in compliance with a clinical guideline; (2) the number of days until the appropriate resolutio n of this episode of breast care if any; and (3) a woman's overall satisfac tion with her care. Sixty-nine percent of women received care consistent wi th 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 mor e likely to receive recommended care and had a shorter time to resolution o f their breast problem. Women with a managed care plan were also more likel y 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 sa tisfaction 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 clini cal guideline, particularly younger women with a clinical breast complaint and a normal or benign-appearing mammogram.