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

J Gen Intern Med. 2000 May;15(5):321-8. doi: 10.1046/j.1525-1497.2000.08030.x.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Breast Neoplasms / diagnostic imaging*
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence
  • Humans
  • Internal Medicine / standards*
  • Mammography*
  • Middle Aged
  • Patient Satisfaction*
  • Primary Health Care / standards*
  • Proportional Hazards Models
  • Quality of Health Care*
  • Time Factors