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. 2015 Feb;24(2):138-43.
doi: 10.1089/jwh.2014.4954. Epub 2014 Dec 18.

Patient navigation to improve follow-up of abnormal mammograms among disadvantaged women

Sanja Percac-Lima  1 , Jeffrey M Ashburner, Anne Marie McCarthy, Sorbarikor Piawah, Steven J Atlas
Affiliations

Patient navigation to improve follow-up of abnormal mammograms among disadvantaged women

Sanja Percac-Lima et al. J Womens Health (Larchmt). 2015 Feb.

Abstract

Background: Patient navigation (PN) can improve breast cancer care among disadvantaged women. We evaluated the impact of a PN program on follow-up after an abnormal mammogram.

Methods: Between 2007 and 2010, disadvantaged women with an abnormal mammogram (Breast Imaging-Reporting and Data System [BI-RADS] codes 0, 3, 4, 5) cared for in a community health center (CHC) with PN were compared to those receiving care in 11 network practices without PN. Multivariable logistic regression and Cox proportional hazards modeling were used to compare the percentages receiving appropriate follow-up and time to follow-up between the groups.

Results: Abnormal mammography findings were reported for 132 women in the CHC with PN and 168 from practices without PN. The percentage of women with appropriate follow-up care was higher in the practice with PN than in non-PN practices (90.4% vs. 75.3%, adjusted p=0.006). RESULTS varied by BI-RADS score for women in PN and non-PN practices (BI-RADS 0, 93.7% vs. 90.2%, p=0.24; BI-RADS 3, 85.7% vs. 49.2%, p=0.003; BI-RADS 4/5, 95.1% vs. 82.8%, p=0.26). Time to follow-up was similar for BI-RADS 0 and occurred sooner for women in the PN practice than in non-PN practices for BI-RADS 3 and 4/5 (BI-RADS 3, adjusted hazard ratio [aHR], 95% confidence interval [CI]: 2.41 [1.36-4.27], BI-RADS 4/5, aHR [95% CI]: 1.41 [0.88-2.24]).

Conclusions: Disadvantaged women from a CHC with PN were more likely to receive appropriate follow-up after an abnormal mammogram than were those from practices without PN. Expanding PN to include all disadvantaged women within primary care networks could improve equity in cancer care.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Proportion of patients who received appropriate follow-up after abnormal mammogram in navigated vs. comparison groups.
<b>FIG. 2.</b>
FIG. 2.
Kaplan-Meier curve for time to follow-up imaging following BI-RADS 0 in navigated vs. comparison groups. Log rank p-value=0.94.
<b>FIG. 3.</b>
FIG. 3.
Kaplan-Meier curve for time to follow-up imaging following BI-RADS 3 in navigated vs. comparison groups. Log rank p-value <0.001.
<b>FIG. 4.</b>
FIG. 4.
Kaplan-Meier curve for time to biopsy following BI-RADS 4/5 in navigated vs. comparison groups. Log rank p-value=0.06.
See this image and copyright information in PMC

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