Satisfaction and anxiety for women during investigation of an abnormal screening mammogram.

Five community-designed pilot projects were undertaken to reduce the time to diagnosis following an abnormal mammogram. One thousand five hundred and seventy-eight women with abnormal mammograms completed a self-administered questionnaire (71% response) which inquired about experiences and satisfaction with time delay from screening to diagnosis, the information received and support given by health professionals, and measures of anxiety and stress during this time interval. Four of the five pilot project initiatives shortened the time interval from screening to diagnosis, the greatest improvement occurring with facilitated referral from screening to diagnostic breast imaging. There was little difference among the pilot projects and control for most measures of client satisfaction and anxiety. Differences were found between biopsied and nonbiopsied women for several of these measures. Shortening the time to diagnosis positively influenced the client's perception of unnecessary delay.

Evaluation of indications for and outcomes of elective surgery.

BACKGROUND: Wide small-area variations in the rates of elective surgical procedures and lack of systematic outcome measurement have raised questions about the appropriateness of such surgery. Our objective was to determine the feasibility of routine evaluation of indications for and outcomes of elective surgery. METHODS: Participants consisted of 138 surgeons and 5313 patients who underwent 1 or more of 6 specific surgical procedures (for a total of 6274 operations). Surgical indications were evaluated according to published guidelines. Patients' self-reported health-related quality of life (HRQOL) before and at appropriate intervals after surgery was measured with standard, validated generic and disease-specific instruments. Patient-specific results were routinely sent to the surgeons, from whom feedback was requested. RESULTS: Surgeons provided information on the indications for surgery for 44% to 95% of the 6 procedures, and the indications matched the guidelines in 73% to 99% of cases. Completed HRQOL questionnaires were returned by 58% of the patients. Postoperative HRQOL scores were markedly improved in most patients, but in 2% to 26% of the various procedures, there was either no change or a deterioration in HRQOL. In most of the procedure groups a small proportion of patients had relatively minor symptoms and disability preoperatively, but in the cataract surgery group this proportion was large. Opinion among the participating surgeons was divided as to the potential value of this method of evaluation. The cost of the outcome evaluation program was about $12/patient. INTERPRETATION: Evaluation of indications for and outcomes of elective surgery could be implemented systematically at reasonable cost and could be included in an accountability framework for health services. Most surgeons were not enthusiastic about this kind of evaluation.