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

Abstract

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. This study used an interrupted time series design with pre- and postanalysis. After institutional review board approval, all diagnostic and ultrasound (US) examinations leading to US-guided biopsy during the phase-in period (May 2021 to February 2022), official implementation period (March 2022 to April 2023), and follow-up period (May 2023 to December 2023) were identified. Demographic characteristics of the groups using Wilcoxon rank-sum tests for continuous variables in χ² 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 postimplementation groups. 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 to 3.5 (interquartile range: 6.0-12.0) days (P < .0001). There was no statistically significant decrease in time from biopsy recommendation to initial surgical (19.0-15.0 days; P = .29) or oncologic (26.0-21.0 days; P = .19) appointment. Implementation of a SDB program is effective in reducing overall diagnostic delays after 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.