Abstract
Introduction: Five community-specific interventions to reduce the time to diagnosis after an abnormal breast screen have been evaluated.
Methods: Subjects with abnormal screening mammograms in 1998 were assessed through five community pilot projects (N=1137) and a control random sample assessed elsewhere in BC (N=1053). The number, types, dates and physician costs of breast-related interventions after an abnormal screen were compared between pilots and control.
Results: The median time to diagnosis for women without a biopsy was reduced from 23 days to 7 days (p = 0.001) in the pilot with facilitated referral to diagnosis. The median time to diagnosis for women with a biopsy was reduced from 57 days to 22–43 days in the pilots. Median physician costs per subject were lower (p = 0.02) in pilots that more frequently used core biopsy to obtain a diagnosis.
Conclusions: Process changes can improve the time to diagnosis after an abnormal breast screen, with similar or lower physician costs per subject. Facilitating the referral process had the greatest impact.
Résumé
Contexte: Nous avons évalué cinq interventions locales particulières visant à réduire les délais de diagnostic lorsqu’un test de dépistage du cancer du sein donne un résultat anormal.
Méthode: Nous avons évalué des patientes dont les clichés mammaires étaient anormaux en 1998 par le biais de cinq projets pilotes communautaires (n=1 137) et évalué un échantillon témoin aléatoire ailleurs en Colombie-Britannique (n=1 053). Nous avons comparé, dans les projets pilotes et chez les cas témoins, le nombre, le genre, les dates et les coûts médicaux des interventions mammaires après un résultat anormal.
Résultats: La durée médiane avant diagnostic pour les femmes n’ayant pas subi de biopsie est passée de 23 à 7 jours (p=0,001) lors du projet pilote où l’on a facilité l’aiguillage vers un diagnostic. La durée médiane avant diagnostic pour les femmes ayant subi une biopsie, qui était de 57 jours, varie maintenant entre 22 et 43 jours. Les coûts médicaux médians par patiente étaient inférieurs (p=0,02) lors des projets pilotes faisant appel aux microbiopsies pour obtenir un diagnostic.
Conclusions: Les modifications aux méthodes peuvent accélérer le diagnostic après un résultat anormal d’un test de dépistage du cancer du sein, tout en maintenant ou en réduisant les coûts médicaux par patiente. C’est en facilitant l’aiguillage des patientes que l’on obtient les effets les plus marqués.
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