Audit Report on the Health and Hospitals Corporation’s Provision of Mammogram Services
AUDIT REPORT IN BRIEF
This audit determined whether New York City Health and Hospitals Corporation (HHC) mammograms were scheduled, conducted, reviewed, and reported in a timely manner. The audit also determined whether the radiologists who interpreted the mammograms were licensed and whether HHC data is accurate on the percentage of women aged 40 to 70 who made a clinic visit to an HHC facility and also received a mammogram within the two-year period prior to the visit.
HHC serves City residents through its 11 acute care hospitals, four skilled nursing facilities, six diagnostic and treatment centers, and more than 80 community-based clinics. HHC provides comprehensive health services, such as medical, mental health, and substance abuse services, to all residents regardless of their ability to pay. HHC facilities have their own programs for cancer prevention, including mammogram services and other detection efforts, to diagnose cancers at an early stage when treatment is more effective and prognoses are more promising. There are two types of mammograms: a routine screening mammogram and, in instances where a lump or potential indication of breast cancer has been found, a more detailed diagnostic mammogram. During Fiscal Year 2009, 97,184 mammograms (both screening and diagnostic) were performed at 16 of the 17 HHC hospitals and diagnostic treatment centers. HHC reported in the Mayor’s Management Report that in Fiscal Year 2009, 71 percent of the women aged 40 to 70 who made a primary care or women’s health visit to an HHC facility had received a mammogram within the two-year period prior to the visit.
Audit Findings and Conclusions
Based on our sample review, HHC facility radiologists read and interpreted mammograms and communicated the results to patients in a timely manner. In addition, the radiologists who interpreted these mammograms were appropriately licensed.
However, some HHC facilities need to reduce the waiting time for screening mammography appointments. At three of the nine facilities we reviewed, the waiting time ranged from 41 days to 148 days, although the waiting time in the other six facilities was five days or less. HHC has established a guideline of 14 days for the maximum amount of time patients should have to wait for the next available appointment for a screening mammogram. The long waiting times at these three facilities may discourage women from following up on their screening mammogram appointments. Studies have shown that women who have to wait a long time for their appointments are more likely to miss their screenings. Furthermore, HHC has not established a standard for the waiting time for diagnostic mammogram appointments. The average waiting time for diagnostic mammography appointments for Fiscal Year 2009 was about 16 days. In view of the fact that the earlier that a breast cancer patient receives treatment, the better it is for the prognosis, HHC needs to establish a standard for diagnostic mammography appointments to help ensure that patients are receiving this vital service in a timely manner.
In addition, in reference to the indicator concerning the percentage of women aged 40 to 70 who made a clinic visit to an HHC facility and also received a mammogram within the two-year period prior to the visit, a concern arose about whether HHC facilities consistently used the correct programming language in the calculation of this indicator. This concern raises questions about the accuracy of the indicator as it has been reported by HHC.
Audit Recommendations
To address the issues, the audit recommends, among other things, that HHC:
- Perform a comprehensive review of its screening services to ensure that all of its facilities can accommodate patients seeking screening mammograms within its waiting time guideline of 14 days. This review could include efficiency analyses, the identification of best practices, and a resource allocation study.
- Develop a written standard concerning patients’ waiting time for receiving diagnostic mammograms ordered by their physicians.
- Ensure that all of its facilities use the correct programming language when calculating the indicator on the percentage of women aged 40 to 70 who made a clinic visit to an HHC facility and also received a mammogram within the two-year period prior to the visit.
Agency Response
In its response, HHC agreed with two of the audit’s four recommendations and stated that it will review the other two recommendations for possible implementation.