This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Roger Hand, MD; Stephen Sener, MD; Joseph Imperato, MD; Joan S. Chmiel, PhD; JoAnne Sylvester, MA; Amy Fremgen, PhD

JAMA. 1991;266(24):3429-3432.

Abstract
Objective.
—To determine the degree of compliance with clinical standards among hospitals for care of breast cancer patients and account for variations in compliance.

Design.
—Analysis of cancer registry data submitted to the American Cancer Society, Illinois Division, Chicago, for a concurrent prospective descriptive study of breast cancer, supplemented by other hospital data from public sources.

Setting.
—Ninety-nine Illinois hospitals evenly distributed among rural counties, counties with small cities outside the Chicago metropolitan area, exurban counties in the Chicago metropolitan area, suburban Cook County, and urban Chicago.

Patients.
—A total of 5766 newly diagnosed patients with histologically confirmed breast cancer in 1988, representing 84% of the estimated 6900 new cases in the state for that year.

Main Outcome Measures.
—Descriptive statistics and multiple linear regression analyses of five dependent quality variables from clinical indicators related to early diagnosis, hormone receptor determination, adjuvant therapy, radiation therapy, and axillary lymph node dissection.

Results.
—At the hospitals studied, (1) late stage (IIb through IV) at diagnosis was associated with urban location, higher proportion of poorly insured patients, fewer breast cancer cases treated, and lower oncology charges (proportion of variance explained, R² =.50, P<.00001); (2) omission of hormone receptor test for stages II through IV was associated with urban location and higher proportion of poorly insured patients (R² =.18, P<.00003); and (3) omission of indicated radiation therapy was associated with urban location and fewer breast cancer cases (R² =.21, P<.00001). Omission of adjuvant therapy and omission of axillary lymph node dissection were not significantly associated with any of the hospital variables examined.

Conclusions.

—The findings suggest that there is a group of urban hospitals, generally small and marginally reimbursed, where comprehensive diagnosis and treatment of breast cancer are not obtained.

(JAMA. 1991;266:3429-3432)

Author Affiliations
From the Department of Medicine, University of Illinois at Chicago College of Medicine (Dr Hand); Departments of Surgery (Dr Sener) and Radiology (Dr Imperato) and Cancer Center Biometry Section (Dr Chmiel), Northwestern University Medical School; and the Cancer Incidence and End Results Committee of the American Cancer Society, Illinois Division, Chicago.

Footnotes
Reprint requests to the Cancer Incidence and End Results Committee, American Cancer Society, Illinois Division, 77E Monroe St, Chicago, IL 60603-3170 (Dr Hand).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Relationship Between the Outcome of Operatively Treated Calcaneal Fractures and Institutional Fracture Load. A Systematic Review of the Literature
Poeze et al.
JBJS 2008;90:1013-1021.
ABSTRACT | FULL TEXT  

The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire's breast cancer patients
Morris et al.
Ann Oncol 2008;19:284-291.
ABSTRACT | FULL TEXT  

Assessment of the quality of breast cancer care: a single institutional study from Saudi Arabia
Akhtar and Nadrah
Int J Qual Health Care 2005;17:301-305.
ABSTRACT | FULL TEXT  

Consultation With a Medical Oncologist Before Surgery and Type of Surgery Among Elderly Women With Early-Stage Breast Cancer
Keating et al.
JCO 2003;21:4532-4539.
ABSTRACT | FULL TEXT  

Cancer Survival in Kentucky and Health Insurance Coverage
McDavid et al.
Arch Intern Med 2003;163:2135-2144.
ABSTRACT | FULL TEXT  

Quality of Breast Cancer Care: What Do We Know?
Malin et al.
JCO 2002;20:4381-4393.
ABSTRACT | FULL TEXT  

Geographic Variations in Breast Cancer Survival Among Older Women: Implications for Quality of Breast Cancer Care
Goodwin et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2002;57:M401-406.
ABSTRACT | FULL TEXT  

Efficacy of Systemic Adjuvant Therapy for Breast Cancer in African-American and Caucasian Women
Dignam
J Natl Cancer Inst Monogr 2001;2001:36-43.
ABSTRACT | FULL TEXT  

Association Between Hospital and Surgeon Procedure Volume and Outcomes of Total Hip Replacement in the United States Medicare Population
Katz et al.
JBJS 2001;83:1622-1629.
ABSTRACT | FULL TEXT  

Determining the Quality of Breast Cancer Care: Do Tumor Registries Measure Up?
Bickell and Chassin
ANN INTERN MED 2000;132:705-710.
ABSTRACT | FULL TEXT  

Variations in the treatment of early-stage breast cancer in Quebec between 1988 and 1994
Hebert-Croteau et al.
CMAJ 1999;161:951-955.
ABSTRACT | FULL TEXT  

Treatment of Breast Cancer
Hortobagyi
NEJM 1998;339:974-984.
FULL TEXT  

Treatment Differences and Other Prognostic Factors Related to Breast Cancer Survival: Delivery Systems and Medical Outcomes
Lee-Feldstein et al.
JAMA 1994;271:1163-1168.
ABSTRACT  

Breast-Conservation Operations for Treatment of Cancer of the Breast
Baue
JAMA 1994;271:1204-1205.
ABSTRACT  

The Importance of Mammographic Screening Relative to the Treatment of Women With Carcinoma of the Breast
Solin et al.
Arch Intern Med 1994;154:745-752.
ABSTRACT  

Health Insurance and Mortality: Evidence From a National Cohort
Franks et al.
JAMA 1993;270:737-741.
ABSTRACT  

Age Differences in the Breast Cancer Management of Rural Women
Howe et al.
J Aging Health 1993;5:402-416.
ABSTRACT  

The Relation between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer
Ayanian et al.
NEJM 1993;329:326-331.
ABSTRACT | FULL TEXT  

Evolution of a Quality-based Compensation Model: The Third Generation
Schlackman
American Journal of Medical Quality 1993;8:103-110.
ABSTRACT  

Quality in Health Care
Laffel and Berwick
JAMA 1992;268:407-409.
ABSTRACT  

Quality of Care
Friedell
JAMA 1992;267:2186-2187.
ABSTRACT  

Quality of Care
Katterhagen and Howe
JAMA 1992;267:2187-2188.
ABSTRACT  

VARIABLE QUALITY OF CARE FOR BREAST CANCER PATIENTS
JWatch General 1992;1992:1-1.
FULL TEXT  

Quality of Care: Time to Act
Chassin
JAMA 1991;266:3472-3473.
ABSTRACT