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
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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. - PowerPoint PPT Presentation
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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 Fellow2Illinois Department of Public Health – Division of Patient Safety and
Quality
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
Background: MIBB
• A hollow needle is inserted into the breast to remove samples of tissue
• Less expensive • Accuracy equivalent to surgical biopsy
“ 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
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
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
BRFSS strata
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
Sample characteristicsPatient characteristic Group Percent of sample (n)
Race White 79.4% (47295)
Black 13.9% (8282)
Latina 6.7% (4014)
Age <=40 12.9% (8304)
40 - <=50 27.5% (17800)
50 - <=60 25.6% (16527)
>60 34.0% (21998)
Payer Medicare 24.9 % (15596)
Medicaid 5.9% (3682)
Private insurance 68% (42614)
Uninsured 1.3% (801)
Zip code median income <$50,000 18.0% (12769)
$50,000 - <$80,000 32.9% (19862)
$80,000 - <$120,000 34.7% (22746)
>= $120,000 14.4% (9252)
BRFSS strata Cook County 35.9% (23177)
Collar counties 25.2% (16295)
Urban counties 22.4% (14472)
Rural counties 16.5% (10685)
Results
2008 2009 20100
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
66.00%
68.00%
70.00%
72.00%
74.00%
76.00%
78.00%
70.23%72.83%
77.11%
MIBB and Surgical Biopsies and Percent of MIBB by Year -- Illinois, 2008-2010
MIBB Surgical Rate of MIBB
Year
Num
ber o
f bio
psie
s
Perc
ent M
IBB
Results: charge
2008 2009 20100.00
2000.00
4000.00
6000.00
8000.00
10000.00
12000.00
$4380.56 $4423.30 $4641.17
$8218.21
$10030.24$11281.63
Average charge by biopsy type and year -- Illinois 2008-2010
MIBB charge Surgical biopsy charge
Results: Chi-square testsPatient characteristic Group Percent MIBB p valueAge <=40 76.0% <.01
41-50 73.4% <.0151-60 73.1% <.05>61 72.1% Ref.
Race White 72.9% RefBlack 76.3% <.01Latina 70.2% <.01