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Disparities in Utilization of Minimally Invasive Breast Biopsy – Illinois, 2008-2010

Disparities in Utilization of Minimally Invasive Breast Biopsy – Illinois, 2008-2010. Julia Fenlon Howland, MPH CPH 1, 2 Barbara Fischer, RN 2 1 CDC/CSTE Applied Epidemiology Fellow 2 Illinois Department of Public Health – Division of Patient Safety and Quality. Background: Definitions.

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Disparities in Utilization of Minimally Invasive Breast Biopsy – Illinois, 2008-2010

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  1. Disparities in Utilization of Minimally Invasive Breast Biopsy – Illinois, 2008-2010 Julia Fenlon Howland, MPH CPH1, 2 Barbara Fischer, RN 2 1CDC/CSTE Applied Epidemiology Fellow 2Illinois Department of Public Health – Division of Patient Safety and Quality

  2. Background: Definitions • A breast biopsy is procedure to remove a small sample of breast tissue for laboratory testing • Used to evaluate a suspicious lesion • Determines whether a lesion is malignant • Minimally invasive breast biopsy (MIBB) or percutaneous breast biopsy • Stereotactic • Ultrasound guided • Vacuum assisted • Surgical biopsy • Incisional • Excisional

  3. Background: MIBB • A hollow needle is inserted into the breast to remove samples of tissue • Local anesthesia • Performed in outpatient settings

  4. Percutaneous: Image-guided Stereotactic Ultrasound guided

  5. Incisional and excisional • Incision made on breast to remove tissue sample, or entire lesion • Patient receives local or general anesthetic • Procedure is done in OR and lasts about an hour

  6. Advantages of MIBB • Shorter recovery time • Fewer operations and re-operations • Fewer surgery-associated complications • Infection • Scarring • Less expensive • Accuracy equivalent to surgical biopsy

  7. “ It was the Panel’s unanimous opinion that percutaneous needle biopsy represents “best practice” and should be the new “gold standard” for initial diagnosis. It should essentially replace open biopsy in this role. The Panel called on the medical community to change their current practice if they are using open surgical breast biopsy as a standard diagnostic procedure. Surgeons should audit their practice and make adjustments to decrease their rate of open biopsy for initial diagnosis to less than 5% to 10%.”- Consensus Conference III, International Breast Cancer Consensus Conference, June 2009

  8. Study questions • Determine the rate of MIBB in Illinois • Identify disparities in utilization of MIBB • Examine charge data associated with MIBB and surgical biopsy • Explore possible reasons for elevated rate of surgical biopsy and disparities in MIBB

  9. Methods: Data Collection • From the Illinois Hospital Discharge Database • Current Procedural Terminology codes 19100, 19102, and 19103 for MIBB and 19101 and 19125 for surgical biopsy • Demographic data • Charge data • Facility data • BRFSS* geographic strata to classify address *BRFSS: Behavioral Risk Factor Surveillance System

  10. BRFSS strata

  11. Methods: Analysis • Chi-square tests: test the significance of the relationships between demographic variables and the rate of MIBB • Logistic regression: test the significance of increases in MIBB rate over time, and the increases in procedure charge over time • Logistic regression: model factors associated with MIBB • We used SAS 9.1 to complete all analysis

  12. Sample characteristics

  13. Results

  14. Results: charge

  15. Results: Chi-square tests

  16. Result: geography *Completed using chi-square tests

  17. Results: Logistic Regression Modeling

  18. Stratified Analysis: Cook County

  19. Stratified Analysis: Collar Counties

  20. Stratified Analysis: Urban Counties

  21. Stratified Analysis: Rural Counties

  22. Rural Facility Analysis

  23. MIBB rate by facility type • Fifteen (83.3%) of the 18 teaching hospitals in Illinois are in Cook County. • All of the 51 critical access hospitals are located outside of Cook County, and 92.2% are located in rural counties.

  24. Access to stereotactic equipment by BRFSS region • Fifty-nine of the 80 rural hospitals (74%) do not have any stereotactic machinery. • Urban counties: 38% no stereotactic equipment • Collar counties: 33% no stereotactic machinery • Cook County: 23% no stereotactic equipment

  25. Conclusions • MIBB is safer, less costly, and yields comparable diagnostic results to surgical biopsy • The rate of MIBB is increasing in Illinois • Despite increases, it remains below the recommended rate of 90-95%

  26. Conclusions: Disparities Identified • Latina women • Women who live outside of Cook County, especially in rural counties • Access to stereotactic equipment

  27. Conclusions: Action Steps • Provider training • Funding for stereotactic machinery • Referral network to nearby providers with stereotactic machinery and appropriately trained providers • Additional investigation is needed to determine reason for excessive surgical biopsies among rural providers

  28. Acknowledgments Barbara Fischer, Illinois Department of Public Health Dr. Craig Conover, Illinois Department of Public Health The Division of Patient Safety and Quality The CDC/CSTE Applied Epidemiology Fellowship Program

  29. Author contact Julia Howland Illinois Department of Public Health Julia.Howland@Illinois.gov 312-793-0098

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