Layeequr Rahman Rakhshanda, Crawford S, Hall Tracey, Bavosi Diane, Quinlan Robert
Department of Surgery, UMass Memorial Health Care, Worcester, MA 01605, USA.
J Am Coll Surg. 2008 Nov;207(5):763-6. doi: 10.1016/j.jamcollsurg.2008.07.006. Epub 2008 Aug 23.
The differences in efficiency, cost of care, and patient satisfaction between surgical-office-based (SB) breast ultrasonography by the surgeon and radiology-referral-based (RB) ultrasonography by the radiologist in the workup of lumps and imaging abnormalities have not been computed.
Charts of 61 consecutive patients requiring breast ultrasonography at the Comprehensive Breast Center from October through December 2005 were evaluated. The SB ultrasonography approach was compared with the RB approach. Matching variables were patient age, presenting complaint, Gail risk score, ultrasonography findings, interventional procedure, and histopathology reports. Outcomes variables were efficiency (time from presentation and establishment of diagnosis), cost of care, and patient satisfaction.
Twenty-nine patients had RB and 32 had SB breast ultrasonography. The RB and SB groups were similar in age, Gail risk, and ultrasonography findings. Median time to establish diagnosis in the RB group was 23 days, versus 1 day in the SB group (p < 0.0001). Median cost of care in the RB versus SB group was $659.00 versus $369.50 (p = 0.253), and net revenue generated was $85.00 versus $195.00 (p = 0.005), respectively. Forty-nine of 61 (80.3%) patients responded to the satisfaction survey. Forty-seven of 49 (96%) patients expect the diagnosis to be established within 48 hours. Twenty-eight of 28 (100%) patients in the SB group regarded their imaging study to be efficient, versus 5 of 21 patients in the RB group (p = 0.005); 16 of 21 in the RB group versus 26 of 28 in the SB group thought they adequately understood the ultrasonography findings at the time of study (p = 0.051). Twenty-four (86%) SB patients versus 14 (67%) RB patients rated overall experience as excellent (p = 0.055).
SB breast ultrasonography is an efficient, cost-effective, and patient-friendly approach to breast problems.
在对乳房肿块及影像异常进行检查时，外科医生在办公室进行的手术式（SB）乳房超声检查与放射科医生基于转诊的（RB）超声检查在效率、护理成本和患者满意度方面的差异尚未得到计算。
对2005年10月至12月在综合乳腺中心连续61例需要进行乳房超声检查的患者病历进行评估。将SB超声检查方法与RB方法进行比较。匹配变量包括患者年龄、主诉、盖尔风险评分、超声检查结果、介入操作及组织病理学报告。结果变量为效率（从就诊到确诊的时间）、护理成本和患者满意度。
29例患者接受RB乳房超声检查，32例接受SB乳房超声检查。RB组和SB组在年龄、盖尔风险及超声检查结果方面相似。RB组确诊的中位时间为23天，而SB组为1天（p < 0.0001）。RB组与SB组的护理中位成本分别为659.00美元和369.50美元（p = 0.253），产生的净收入分别为85.00美元和195.00美元（p = 0.005）。61例患者中有49例（80.3%）回复了满意度调查。49例患者中有47例（96%）期望在48小时内确诊。SB组28例患者中有28例（100%）认为其影像检查高效，而RB组21例患者中有5例（p = 0.005）；RB组21例中有16例，SB组28例中有26例认为他们在检查时充分理解了超声检查结果（p = 0.051）。24例（86%）SB患者与14例（67%）RB患者将总体体验评为优秀（p = 0.055）。
SB乳房超声检查是一种针对乳房问题的高效、经济且患者友好的方法。
