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Low-income women with breast abnormalities: system predictors of timely diagnostic resolution.

BACKGROUND
Incomplete or delayed diagnostic resolution of breast abnormalities suspicious for cancer may contribute to poor breast cancer outcomes. We examine system predictors of timely diagnostic resolution in low-income, mostly Latina women with breast abnormalities at two Los Angeles County public hospitals.


METHODS
We collected medical record data on 1,671 women. The outcome--timely diagnostic resolution--was defined as receipt of definitive diagnosis (malignant or benign) within six months of the index referral. Predictors of the outcome were examined with bivariate and multivariate logistic regression models.


RESULTS
Only 56% of women received timely diagnostic resolution; however, the proportion was higher at Hospital B (67%) compared to Hospital A (51%). The effect of predictors differed by hospital. At Hospital B, the odds of timely diagnostic resolution were lower for women with self-identified abnormalities (P <.033) and higher for women referred to Radiology rather than Surgery for their first appointment (P <.005). At Hospital A, the odds of timely diagnostic resolution were higher for women with self-identified abnormalities (P <.043) and lower for women referred to Radiology rather than Surgery for their first appointment (P <.001).


CONCLUSIONS
Rates and predictors of timely diagnostic resolution differed by hospital. System barriers may be a function of referral processes and patient tracking. Interventions may need to be tailored to a hospital's unique culture.