Does insurance mix impact utilization of published care practices and guidelines among breast imaging sites?
150 Background: Significant variation exists across Metropolitan Chicago in the quality and timeliness measures for breast cancer detection (Rauscher GH 2014). We examined utilization of published care practices and guidelines at breast imaging sites in Chicago and compared them based on insurance mix. Methods: We conducted an IRB approved web survey of all 58 breast imaging sites in Chicago. Using guidelines (NCCN, NAPBC, ACR) and peer-reviewed literature (38 studies) we developed a survey of breast diagnostic practices. Results analyzed using simple frequencies and Fisher's exact test. Results: We achieved a response rate of 91% (53/58 sites): 27 sites with over 40% privately insured (PI) patients and 26 sites with over 60% Medicare, Medicaid, charity and self pay (MM) patients (IDPH 2012). Utilization of practices vary (Table). The use of breast MRI for diagnostic patients is 81% (17/21) of PI vs. 47% (8/17) of MM sites, p=0.04. Image guided biopsy is used by 81% (17/21) of PI vs. 25% (3/12) of MM sites, p=0.03. Clip placement at biopsy is done at 86% (18/21) of PI vs. 50% (6/12) of MM sites, p=0.04. Conclusions: Sites with higher rates of private insurance show better utilization of three published breast cancer diagnostic care practices. However, improvement is needed across sites, regardless of insurance mix, to provide care to all patients that is up-to-date on published breast cancer screening and diagnostic practices. [Table: see text]