Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas

Nina P. Tamirisa, Kristin M. Sheffield, Abhishek D. Parmar, Christopher J. Zimmermann, Deepak Adhikari, Gabriela M. Vargas, Yong Fang Kuo, James Goodwin, Taylor S. Riall

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE AND BACKGROUND: Minimally invasive breast biopsy (MIBB) rates remain well below guideline recommendations of more than 90% and vary across geographic areas. Our aim was to determine the variation in use attributable to the surgeon and facility and determine the patient, surgeon, and facility characteristics associated with the use of MIBB. METHODS: We used 100% Texas Medicare claims data (2000-2008) to identify women older than 66 years with a breast biopsy (open or minimally invasive) and subsequent breast cancer diagnosis/operation within 1 year. The percentage of patients undergoing MIBB as the first diagnostic modality was estimated for each surgeon and facility. Three-level hierarchical generalized linear models (patients clustered within surgeons within facilities) were used to evaluate variation in MIBB use. RESULTS: A total of 22,711 patients underwent a breast cancer operation by 1226 surgeons at 525 facilities. MIBB was the initial diagnostic modality in 62.4% of cases. Only 7.0% of facilities and 12.9% of surgeons used MIBB for more than 90% of patients. In 3-level models adjusted for patient characteristics, the percentage of patients who received MIBB ranged from 7.5% to 96.0% across facilities (mean = 50.1%, median = 49.2%) and from 8.0% to 87.0% across surgeons (mean = 50.3%, median = 50.9%). The variance in MIBB use was attributable to facility (8.8%) and surgeon (15.4%) characteristics. Lower surgeon and facility volume, longer surgeon years in practice, and smaller facility bed size were associated with lower rates of MIBB use. CONCLUSIONS: Identification of surgeon and facility characteristics associated with low use of MIBB provides potential targets for interventions to improve MIBB rates and decrease variation in use. TYPE OF STUDY: Retrospective cohort.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Sep 1 2014

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Breast
Biopsy
Surgeons
Hospital Bed Capacity
Breast Neoplasms
Medicare
Linear Models
Guidelines

ASJC Scopus subject areas

  • Surgery

Cite this

Tamirisa, N. P., Sheffield, K. M., Parmar, A. D., Zimmermann, C. J., Adhikari, D., Vargas, G. M., ... Riall, T. S. (Accepted/In press). Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000000883

Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas. / Tamirisa, Nina P.; Sheffield, Kristin M.; Parmar, Abhishek D.; Zimmermann, Christopher J.; Adhikari, Deepak; Vargas, Gabriela M.; Kuo, Yong Fang; Goodwin, James; Riall, Taylor S.

In: Annals of Surgery, 01.09.2014.

Research output: Contribution to journalArticle

Tamirisa NP, Sheffield KM, Parmar AD, Zimmermann CJ, Adhikari D, Vargas GM et al. Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas. Annals of Surgery. 2014 Sep 1. https://doi.org/10.1097/SLA.0000000000000883
Tamirisa, Nina P. ; Sheffield, Kristin M. ; Parmar, Abhishek D. ; Zimmermann, Christopher J. ; Adhikari, Deepak ; Vargas, Gabriela M. ; Kuo, Yong Fang ; Goodwin, James ; Riall, Taylor S. / Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas. In: Annals of Surgery. 2014.
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abstract = "OBJECTIVE AND BACKGROUND: Minimally invasive breast biopsy (MIBB) rates remain well below guideline recommendations of more than 90{\%} and vary across geographic areas. Our aim was to determine the variation in use attributable to the surgeon and facility and determine the patient, surgeon, and facility characteristics associated with the use of MIBB. METHODS: We used 100{\%} Texas Medicare claims data (2000-2008) to identify women older than 66 years with a breast biopsy (open or minimally invasive) and subsequent breast cancer diagnosis/operation within 1 year. The percentage of patients undergoing MIBB as the first diagnostic modality was estimated for each surgeon and facility. Three-level hierarchical generalized linear models (patients clustered within surgeons within facilities) were used to evaluate variation in MIBB use. RESULTS: A total of 22,711 patients underwent a breast cancer operation by 1226 surgeons at 525 facilities. MIBB was the initial diagnostic modality in 62.4{\%} of cases. Only 7.0{\%} of facilities and 12.9{\%} of surgeons used MIBB for more than 90{\%} of patients. In 3-level models adjusted for patient characteristics, the percentage of patients who received MIBB ranged from 7.5{\%} to 96.0{\%} across facilities (mean = 50.1{\%}, median = 49.2{\%}) and from 8.0{\%} to 87.0{\%} across surgeons (mean = 50.3{\%}, median = 50.9{\%}). The variance in MIBB use was attributable to facility (8.8{\%}) and surgeon (15.4{\%}) characteristics. Lower surgeon and facility volume, longer surgeon years in practice, and smaller facility bed size were associated with lower rates of MIBB use. CONCLUSIONS: Identification of surgeon and facility characteristics associated with low use of MIBB provides potential targets for interventions to improve MIBB rates and decrease variation in use. TYPE OF STUDY: Retrospective cohort.",
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AU - Tamirisa, Nina P.

AU - Sheffield, Kristin M.

AU - Parmar, Abhishek D.

AU - Zimmermann, Christopher J.

AU - Adhikari, Deepak

AU - Vargas, Gabriela M.

AU - Kuo, Yong Fang

AU - Goodwin, James

AU - Riall, Taylor S.

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N2 - OBJECTIVE AND BACKGROUND: Minimally invasive breast biopsy (MIBB) rates remain well below guideline recommendations of more than 90% and vary across geographic areas. Our aim was to determine the variation in use attributable to the surgeon and facility and determine the patient, surgeon, and facility characteristics associated with the use of MIBB. METHODS: We used 100% Texas Medicare claims data (2000-2008) to identify women older than 66 years with a breast biopsy (open or minimally invasive) and subsequent breast cancer diagnosis/operation within 1 year. The percentage of patients undergoing MIBB as the first diagnostic modality was estimated for each surgeon and facility. Three-level hierarchical generalized linear models (patients clustered within surgeons within facilities) were used to evaluate variation in MIBB use. RESULTS: A total of 22,711 patients underwent a breast cancer operation by 1226 surgeons at 525 facilities. MIBB was the initial diagnostic modality in 62.4% of cases. Only 7.0% of facilities and 12.9% of surgeons used MIBB for more than 90% of patients. In 3-level models adjusted for patient characteristics, the percentage of patients who received MIBB ranged from 7.5% to 96.0% across facilities (mean = 50.1%, median = 49.2%) and from 8.0% to 87.0% across surgeons (mean = 50.3%, median = 50.9%). The variance in MIBB use was attributable to facility (8.8%) and surgeon (15.4%) characteristics. Lower surgeon and facility volume, longer surgeon years in practice, and smaller facility bed size were associated with lower rates of MIBB use. CONCLUSIONS: Identification of surgeon and facility characteristics associated with low use of MIBB provides potential targets for interventions to improve MIBB rates and decrease variation in use. TYPE OF STUDY: Retrospective cohort.

AB - OBJECTIVE AND BACKGROUND: Minimally invasive breast biopsy (MIBB) rates remain well below guideline recommendations of more than 90% and vary across geographic areas. Our aim was to determine the variation in use attributable to the surgeon and facility and determine the patient, surgeon, and facility characteristics associated with the use of MIBB. METHODS: We used 100% Texas Medicare claims data (2000-2008) to identify women older than 66 years with a breast biopsy (open or minimally invasive) and subsequent breast cancer diagnosis/operation within 1 year. The percentage of patients undergoing MIBB as the first diagnostic modality was estimated for each surgeon and facility. Three-level hierarchical generalized linear models (patients clustered within surgeons within facilities) were used to evaluate variation in MIBB use. RESULTS: A total of 22,711 patients underwent a breast cancer operation by 1226 surgeons at 525 facilities. MIBB was the initial diagnostic modality in 62.4% of cases. Only 7.0% of facilities and 12.9% of surgeons used MIBB for more than 90% of patients. In 3-level models adjusted for patient characteristics, the percentage of patients who received MIBB ranged from 7.5% to 96.0% across facilities (mean = 50.1%, median = 49.2%) and from 8.0% to 87.0% across surgeons (mean = 50.3%, median = 50.9%). The variance in MIBB use was attributable to facility (8.8%) and surgeon (15.4%) characteristics. Lower surgeon and facility volume, longer surgeon years in practice, and smaller facility bed size were associated with lower rates of MIBB use. CONCLUSIONS: Identification of surgeon and facility characteristics associated with low use of MIBB provides potential targets for interventions to improve MIBB rates and decrease variation in use. TYPE OF STUDY: Retrospective cohort.

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