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Surgical-Office-Based vs. Radiology-Based Breast Ultrasound: A Comparison of Efficiency, Cost and Patient-Satisfaction
Rakhshanda Layeeque, Tracey Hall, Diane Bavosi, Robert M Quinlan
UMass Memorial Health Center, Worcester, MA
Objective: To compute the differences in efficiency, cost of care and patient satisfaction between the surgical-office-based (SOB) breast ultrasound by the surgeon and the radiology-referral-based (RRB) ultrasound by the radiologist in the work up of lumps and imaging abnormalities.
Design: Retrospective.
Setting: University Comprehensive Breast Center.
Patients: Consecutive clinic patients over 3 months requiring breast ultrasounds. SOB ultrasound was compared with the RRB approach.
Main Outcome Measures: Matching variables- Age, presenting complaint, Gail-risk and ultrasound findings. Outcome variables- Efficiency (time between presentation and establishment of diagnosis), cost of care and patient satisfaction (survey questionnaire).
Results: Twenty-nine patients had RRB while 32 had SOB breast ultrasounds. The RRB and SOB groups were similar in age, Gail-risk, and ultrasound findings. Median(25th-75th centile) time to establish the diagnosis in RRB vs. SOB group was 23(14-39) vs. 1(1-2) days [p<0.0001]. Median(25th-75th centile) cost of care in RRB vs. SOB group was .0(324-810) vs. .5(266-752) [p=0.253], while the net revenue generated was .0(39-212) vs. .0(103.5-658.5) [0.005] respectively. 49/61(80.3%) patients responded to the satisfaction survey. 47/49(96%) patients expect the diagnosis within 48 hours. 28/28(100%) patients in the SOB group regarded their ultrasound to be efficient vs. 5/21 patients in the RRB group [p=0.005]; 16/21 in the RRB group vs. 26/28 in the SOB group thought they understood the ultrasound findings at the time of study [p=0.051]. 24(86%) SOB patients vs. 14(67%) RRB patients rated overall experience as excellent [p=0.055]
Conclusions: SOB breast ultrasound is an efficient, cost-effective and patient-friendly approach towards breast problems.
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