Background: The influence of organizational characteristics on delays in breast cancer diagnosis remains poorly understood. The present study provides new insights by using a population-based sample of female Medicare patients diagnosed with breast cancer to examine the effect of several organizational characteristics (ownership, specialized capabilities, system membership, and size) on delays between initial physician-patient consultation or mammography and confirmation of breast cancer diagnosis.
Methods: Study data were derived from the Kentucky, North Carolina, Ohio, and Pennsylvania state central cancer registries (2006-2008). We then linked Medicare enrollment files and claims data (2005-2009), the Area Resource File, and the American Hospital Association Annual Survey of Hospitals to create an integrated data set. We used standard ordinary least squares (OLS) to regress the natural log of breast cancer diagnosis delay on a number of organization-level, demographic, and clinical characteristics. As a robustness check on one of our organization-level variables (ownership), we performed propensity score matching using the nearest neighbor methodology and re-ran an OLS regression on the reduced data sample.
Results: The baseline study sample consisted of 4,547 breast cancer patients enrolled in Medicare. We found that hospitals with for-profit ownership (p<.01) and those with comprehensive oncology services (p<.10) had shorter diagnosis delays than their counterparts. Estimates for system membership and size were not statistically significant at conventional levels.
Conclusion(s): Some structural characteristics of hospitals (ownership, specialized capabilities) are associated with the degree of delay in diagnosing breast cancer. Researchers must go beyond examining demographic and clinical characteristics to understand timely cancer diagnosis.
der1 [at] columbia [dot] edu