Massachusetts General Hospital, Boston, Massachusetts.
Massachusetts General Hospital, Boston, Massachusetts.
J Am Coll Radiol. 2019 Nov;16(11):1554-1560. doi: 10.1016/j.jacr.2019.05.011. Epub 2019 May 29.
Disparities in breast cancer diagnosis are established. In usual practice, biopsies are performed days or weeks after recommendation. Our aim was to measure the impact of a same-day biopsy program on disparities in time from biopsy recommendation to performance.
After Institutional Review Board approval, we identified all diagnostic examinations leading to biopsy pre- (September 2016 to March 2017) and post- (September 2017 to March 2018) implementation of our same-day biopsy program. We compared demographic characteristics (age, race, language, and insurance) and biopsy information (days from biopsy recommendation to biopsy, and proportion of same-day biopsies in all biopsies) in pre- versus postimplementation groups. Multivariable linear and logistic models in pre- and postimplementation groups assessed if days from biopsy recommendation to biopsy and having a same-day biopsy were associated with patient subgroups.
In all, 663 and 482 patients underwent biopsy during pre- and postimplementation periods, respectively. Patient subgroups were similar between periods. For all patients, the same-day biopsy program decreased median time from diagnostic examination to biopsy from 8 (interquartile range: 4-13) to 0 (interquartile range: 0-4) days (P < .001). During the pre-implementation period, nonwhite patients and having Medicare insurance were associated with longer days to biopsy (nonwhite Adjusted Coefficient: 2.31, 95% confidence interval [CI]: 0.58-4.03; insurance Adjusted Coefficient: 2.47, 95% CI: 0.58-4.37; P < .05), after adjustment. During the postimplementation period, the previously seen disparities did not persist (nonwhite Adjusted Coefficient: -0.416, 95% CI: -2.16-1.33; insurance Adjusted Coefficient: 0.812, 95% CI: -1.18-2.80; P > .05).
There was no evidence of racial/ethnic or insurance disparities in time from biopsy recommendation to performance after implementation of a same-day biopsy program.
乳腺癌诊断中的差异是既定的。在常规实践中，活检是在推荐后的几天或几周内进行的。我们的目的是衡量实施当日活检计划对活检推荐到执行之间时间差异的影响。
在获得机构审查委员会批准后，我们确定了所有导致活检的诊断检查，这些检查是在实施当日活检计划之前（2016 年 9 月至 2017 年 3 月）和之后（2017 年 9 月至 2018 年 3 月）进行的。我们比较了预实施组和实施后组之间的人口统计学特征（年龄、种族、语言和保险）和活检信息（从活检推荐到活检的天数，以及所有活检中当日活检的比例）。在预实施组和实施后组中，多元线性和逻辑模型评估了活检推荐到活检的天数和当日活检与患者亚组的相关性。
共有 663 名和 482 名患者分别在预实施组和实施后组中进行了活检。两个时期的患者亚组相似。对于所有患者，从诊断检查到活检的当日活检计划将中位数从 8 天（四分位距：4-13）减少到 0 天（四分位距：0-4）（P<0.001）。在实施前阶段，非白人患者和医疗保险患者与活检时间延长相关（非白人调整后的系数：2.31，95%置信区间[CI]：0.58-4.03；保险调整后的系数：2.47，95% CI：0.58-4.37；P<0.05）。在实施后阶段，之前看到的差异不再存在（非白人调整后的系数：-0.416，95% CI：-2.16-1.33；保险调整后的系数：0.812，95% CI：-1.18-2.80；P>0.05）。
实施当日活检计划后，在活检推荐到执行之间的时间上没有种族/民族或保险差异的证据。
