{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:56:43Z","timestamp":1790344603519,"version":"4.1.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:00:00Z","timestamp":1694131200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute on Minority Health and Health Disparities of the National Institutes of Health","award":["R01MD016386"],"award-info":[{"award-number":["R01MD016386"]}]},{"DOI":"10.13039\/100004334","name":"Merck","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Postmenopausal bleeding (PMB) is a common gynecologic condition. Although it can be a sign of uterine cancer, most patients have benign etiology. However, research on quality of diagnostic evaluation for PMB has been limited to cancer patients. To extend this research, we examined the timeliness of diagnostic evaluation for PMB among patients with benign conditions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Using the 2008\u20132019 MarketScan Research Databases, we identified 499176 patients (456741 with commercial insurance and 42435 with Medicaid insurance) who presented with PMB but did not have gynecologic cancer. For each patient, we measured the time from their PMB reporting to the date of their first diagnostic procedure. The association between patient characteristics and time to first diagnostic procedure was examined using Cox proportional hazards models (for the overall sample and then stratified by insurance type).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, 54.3% of patients received a diagnostic procedure on the same day when they reported PMB and 86.6% received a diagnostic procedure within 12 months after reporting PMB. These percentages were 39.4% and 77.1%, respectively, for Medicaid patients, compared to 55.7% and 87.4%, respectively, for commercially insured patients (p&lt;0.001 for both). Medicaid patients had an 18% lower rate of receiving a diagnostic procedure at any given time point than commercially insured patients (adjusted hazard ratio = 0.82, 95% CI: 0.81\u20130.83). Meanwhile, older age and non-gynecologic comorbidities were associated with a lower rate whereas concomitant gynecologic conditions and recent use of preventive care were associated with a higher rate of receiving diagnostic procedures. Analysis stratified by insurance type identified additional risk factors for delayed diagnostic procedures (e.g., non-metropolitan versus metropolitan location for commercially insured patients and Black versus White race for Medicaid patients).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>A sizable proportion of patients did not receive prompt diagnostic evaluation for PMB. Both clinical and non-clinical factors could affect timeliness of evaluation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0289692","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T17:37:19Z","timestamp":1694194639000},"page":"e0289692","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6519-1731","authenticated-orcid":true,"given":"Xiao","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Nunez-Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"issue":"6","key":"pone.0289692.ref001","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1016\/j.ajog.2006.03.010","article-title":"A comprehensive women\u2019s health care center: Are gynecologists offering primary care?","volume":"194","author":"GM Lentz","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"pone.0289692.ref002","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1097\/01.AOG.0000428646.67925.9a","article-title":"ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women","volume":"121","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"5","key":"pone.0289692.ref003","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1097\/AOG.0000000000002631","article-title":"ACOG Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding","volume":"131","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"6","key":"pone.0289692.ref004","doi-asserted-by":"crossref","first-page":"593 e1","DOI":"10.1016\/j.ajog.2018.09.040","article-title":"Role of bleeding recognition and evaluation in Black-White disparities in endometrial cancer","volume":"219","author":"KM Doll","year":"2018","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"pone.0289692.ref005","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1093\/jnci\/djad027","article-title":"Racial disparities in diagnostic evaluation of uterine cancer among Medicaid beneficiaries","volume":"115","author":"X Xu","year":"2023","journal-title":"J Natl Cancer Inst"},{"issue":"9","key":"pone.0289692.ref006","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1001\/jamainternmed.2018.2820","article-title":"Association of endometrial cancer risk with postmenopausal bleeding in women: A systematic review and meta-analysis","volume":"178","author":"MA Clarke","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"1","key":"pone.0289692.ref007","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ijgo.2010.11.011","article-title":"FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age","volume":"113","author":"FIGO Working Group on Menstrual Disorders","year":"2011","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0289692.ref008","volume-title":"StatPearls","author":"S Sung","year":"2022"},{"issue":"8","key":"pone.0289692.ref009","doi-asserted-by":"crossref","first-page":"5919","DOI":"10.3390\/curroncol29080467","article-title":"Patient-reported experiences of breast cancer screening, diagnosis, and treatment delay, and telemedicine adoption during COVID-19","volume":"29","author":"S Du","year":"2022","journal-title":"Curr Oncol"},{"issue":"2","key":"pone.0289692.ref010","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.RVW.21.00139","article-title":"Socioeconomic Status Impacts Access to Orthopaedic Specialty Care","volume":"10","author":"S Resad Ferati","year":"2022","journal-title":"JBJS Rev"},{"issue":"4","key":"pone.0289692.ref011","first-page":"645","volume":"139","author":"S Whetstone","year":"2022","journal-title":"Health disparities in uterine cancer: Report from the Uterine Cancer Evidence Review Conference. 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