Evidence map›Paper›PMID 31011969›Full record

ArticleJournal of general internal medicine2019

Comparing Diagnostic Evaluations for Rectal Bleeding and Breast Lumps in Primary Care: a Retrospective Cohort Study.

Lydia E Pace, Sanja Percac-Lima, Kevin H Nguyen, Charis N Crofton, Katharine A Normandin, Sara J Singer, Meredith B Rosenthal, Alyna T Chien

Open access · bronzeAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of general internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.2field-weighted citation impact, top 43% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 3 citations in OpenAlex.

  1. Trial
  2. Article
  3. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Lydia E PaceHarvard Medical School, Boston, MA, USA. lpace@bwh.harvard.edu.
Sanja Percac-LimaHarvard Medical School, Boston, MA, USA.
Kevin H NguyenDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Charis N CroftonDivision of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
Katharine A NormandinDivision of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
Sara J SingerDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Meredith B RosenthalDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Alyna T ChienHarvard Medical School, Boston, MA, USA.
Harvard University · USBoston Children's Hospital · USMassachusetts General Hospital · US

Funding

Evaluating breast cancer care in rural RwandaK07CA215819 · NCI · BRIGHAM AND WOMEN'S HOSPITAL · PI PACE, LYDIA · 2018 to 2023
$1.0M
NCI NIH HHS K07 CA215819
6 · The paper itself

Abstract

backgroundInadequate diagnostic evaluations of breast lumps and rectal bleeding in primary care are an important source of medical errors. Delays appear particularly common in evaluation of rectal bleeding. Comparing pursuit and completion of diagnostic testing for these two conditions within the same practice settings could help highlight barriers and inform interventions.

objectivesTo examine processes undertaken for diagnostic evaluations of breast lumps and rectal bleeding within the same practices and to compare them with regard to (a) the likelihood that diagnostic tests are ordered according to guidelines and (b) the timeliness of order placement and completion.

designA retrospective cohort study using explicit chart abstraction methods.

participantsThree hundred women aged 30-80 presenting with breast lumps and 300 men and women aged 40-80 years presenting with rectal bleeding to 15 academically affiliated primary care practices, 2012-2016. MAIN MEASURES: Rates and timing of test ordering and completion and patterns of visits and communications. KEY

resultsAt initial presentation, physicians ordered recommended imaging or procedures at higher rates for patients with breast lumps compared to those with rectal bleeding (97% vs. 86% of patients recommended to receive imaging or endoscopy; p < 0.01). Most (90%) patients with breast lumps completed recommended diagnostic testing within 1 month, versus 31% of patients with rectal bleeding (p < 0.01). By 1 year, 7% of patients with breast lumps had not completed indicated imaging, versus 27% of those with rectal bleeding. Patients with breast lumps had fewer subsequent primary care visits related or unrelated to their symptom and had fewer related communications with specialists. LIMITATIONS: The study relied on documented care, and findings may be most generalizable to academically affiliated institutions.

conclusionsDiagnostic processes for rectal bleeding were less frequently guideline-concordant and timely than those for breast lumps. The largest discrepancies occurred in initial ordering of indicated tests and the timeliness of test completion.

Indexed as

RectumAdultAgedAged, 80 and overBreast NeoplasmsCohort StudiesDiagnostic Tests, RoutineFemaleFollow-Up StudiesGastrointestinal HemorrhageHumansMaleMiddle AgedPhysical ExaminationPrimary Health CareRetrospective Studiesbreast lumpscare qualitydiagnosisprimary carerectal bleeding

Identifiers

PMID31011969
PMCPMC6614558
OpenAlexW2940600133

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.