Racial/Ethnic Disparities in Time to a Breast Cancer Diagnosis The Mediating Effects of Health Care Facility Factors
Racial/Ethnic Disparities in Time to a Breast Cancer Diagnosis The Mediating Effects of Health Care Facility Factors
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DOI：
10.1097/mlr.0000000000000417
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发表时间：
2015-10-01
期刊：
影响因子：
3
通讯作者：
Rauscher, Garth H.
中科院分区：
文献类型：
--
作者：
Molina, Yamile;Silva, Abigail;Rauscher, Garth H.
背景：种族/民族差异存在沿着乳腺癌连续体，包括诊断的时间。以前的研究主要集中在患者层面的因素，少是已知的作用，医疗保健设施可能发挥在延迟乳腺癌career.Objectives：我们研究了种族/民族差异延迟诊断乳腺癌的乳腺癌护理在芝加哥Study和估计潜在的中介作用设施factors.Research设计和科目：乳腺癌患者（N=606）提供了访谈和病历数据的一部分，人口为基础的study.Measures：种族/民族是自我报告的采访。诊断延迟被定义为医疗表现和明确诊断之间超过60天。设施因素包括以下方面的医疗介绍设施：（1）通过国家乳腺中心联盟的认证;（2）通过美国放射学院的卓越乳腺成像中心认证;（3）作为伊利诺斯州不成比例的共享医院的地位以及在介绍和诊断之间使用的设施数量。相对于非西班牙裔白人，少数民族更有可能经历诊断延迟，目前在一个未经认可的设施，并在一个不成比例的共享医院，并涉及多个设施在他们的诊断。总的来说，设施因素占诊断延迟差异的43%（P
Background:Racial/ethnic disparities exist along the breast cancer continuum, including time to a diagnosis. Previous research has largely focused on patient-level factors, and less is known about the role that health care facilities may play in delayed breast cancer care.Objectives:We examined racial/ethnic disparities in delayed diagnosis for breast cancer in the Breast Cancer Care in Chicago Study and estimated the potential mediating effects of facility factors.Research Design and Subjects:Breast cancer patients (N=606) contributed interview and medical record data as part of a population-based study.Measures:Race/ethnicity was self-reported at interview. Diagnostic delay was defined as an excess of 60 days between medical presentation and a definitive diagnosis. Facility factors included the facility of medical presentation with respect to: (1) accreditation through the National Consortium of Breast Centers; (2) certification as a Breast Imaging Center of Excellence through the American College of Radiology; and (3) status as a disproportionate share hospital through the state of Illinois as well as the number of facilities used between presentation and diagnosis.Results:Relative to non-Hispanic whites, minorities were more likely to experience a diagnostic delay, present at a nonaccredited facility and at a disproportionate share hospital, and involve multiple facilities in their diagnosis. Together, facility factors accounted for 43% of the disparity in diagnostic delay (P