Outcomes of Implementation of a Same-Day Breast Biopsy Program in a Safety-Net Public Hospital.

Abstract

Purpose: Safety-net hospitals play an important role in providing care to patients from historically underserved groups, representing a natural target for initiatives to reduce health disparities. This study evaluates the implementation of a same day biopsy (SDB) program on time to breast biopsy in the safety-net setting.

Materials & methods: This study utilized an interrupted time series design with pre- and post- analysis. After IRB approval, all diagnostic and ultrasound (US) examinations leading to US-guided biopsy during the phase-in period (May 2021-February 2022), official implementation period (March 2022-April 2023), and follow-up period (May 2023-December 2023) were identified. Demographic characteristics of the groups using Wilcoxon rank-sum tests for continuous variables in chi square tests of independence for categorical variables were evaluated. Spline modeling with generalized linear models was used to assess differences in days from biopsy recommendation to biopsy and rates of having a SDB in pre- and post-implementation groups.

Results: A total of 677 patients received recommended US-guided breast biopsies during the study period, with 233 patients in the phase-in group, 306 patients in the official implementation group, and 138 patients in the follow-up group. For all patients, the SDB program reduced the median time from biopsy recommendation to biopsy from 13.0-3.5 (IQR: 6.0-12.0) days (P < 0.0001). There was no statistically significant decrease in time from biopsy recommendation to initial surgical (19.0-15.0 days; P=0.29) or oncologic (26.0-21.0 days; P=0.19) appointment.

Conclusion: Implementation of a SDB program is effective in reducing overall diagnostic delays following a breast biopsy recommendation for patients seen in safety net institutions. Additional administrative and ancillary support may be required however to aid surgical and oncologic services to further improve overall time to treatment in these settings.