Quality of Breast Cancer Care: The Role of Hispanic Ethnicity, Language, and Socioeconomic Position
Abstract
Using data from a population-based sample of breast cancer patients in Los Angeles County. Their physicians, and neighborhood data, our goal is to examine the relative importance of ethnicity, language, and socio-economic position, and how they relate to structure, process, and outcomes of breast cancer care. In neighborhood-level analyses, Hispanic neighborhood was statistically significantly associated with numerous measures of socio-economic resources and acculturation. In patient-level analyses, we found evidence of socio-economic disparities in breast cancer decision-making and treatment: 1) Low-income was a barrier to breast reconstruction discussion and receipt; 2) Physician-patient discussion of treatment outcomes was correlated with patient satisfaction; 3) Older and lower income women were at higher risk of not participating in decision-making. Ethnic differences appeared to be explained by socio-economic status in these analyses. In provider-level analyses: 1) Physicians reported high career satisfaction levels but were least satisfied with time spent with patients; 2) Explicit financial incentives tied to performance on quality measures were reported at modest rates, primarily associated with HMO settings; 3) Most frequent reports of financial incentives to perform more services were among medical oncologists performing office-based chemotherapy and growth factor injections; 4) Treating more limited English-proficient patients was associated with decreased physician satisfaction with time spent with patients; 5) Greater intensity of interpreter service use ameliorated some of this dissatisfaction.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jun 01, 2007
- Accession Number
- ADA476741
Entities
People
- Diana M. Tisnado
- Katherine L. Kahn
Organizations
- University of California, Los Angeles