Patient Navigation to Increase Mammography Screening Among Inner City Women

• Published in: Journal of general internal medicine : JGIM 2011-02, Vol.26 (2), p.123-129
• Main Authors: Phillips, Christine E., Rothstein, Jessica D., Beaver, Kristine, Sherman, Bonnie J., Freund, Karen M., Battaglia, Tracy A.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - ethnology; Continuity of Patient Care - standards; Continuity of Patient Care - trends; Electronic Health Records - standards; Electronic Health Records - trends; Female; General aspects; Genital system. Mammary gland; Health behavior; Healthcare Disparities - standards; Healthcare Disparities - trends; Humans; Inner city; Internal Medicine; Investigative techniques, diagnostic techniques (general aspects); Mammography; Mammography - standards; Mammography - trends; Mass Screening - psychology; Mass Screening - standards; Mass Screening - trends; Medical sciences; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Original Research; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Urban Population - trends; Women - psychology; Womens health
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-010-1527-2

Background Lower mammography screening rates among minority and low income women contribute to increased morbidity and mortality from breast cancer. Objective To evaluate the effect of a patient navigation intervention on adherence rates to biennial screening mammography among women engaged in primary care at an inner-city academic medical center. Design Quality improvement intervention with a concurrent control group, conducted from February to November of 2008. Study Subjects All women in a hospital-based primary care practice aged 51–70 years. Subjects were randomized at the level of their primary care provider, such that half of the patients in the practice received the intervention, while the other half received usual care. Interventions Intervention subjects whose last mammogram was >18 months prior received a combination of telephone calls and reminder letters from patient navigators trained to identify barriers to care. Navigators were integrated into primary care teams and interacted directly with patients, providers, and radiology to coordinate care. Navigators utilized an electronic report to track subjects. Adherence rates to biennial mammography were assessed in intervention and control groups at baseline and post-intervention. Key Results A total of 3,895 women were randomized to intervention (n = 1,817) and control (n = 2,078) groups. Mean age was 60, 71% were racial/ethnic minorities, 23% were non-English speaking, and 63% had public or no health insurance. At baseline, there was no difference in mammography adherence between the control and intervention groups (78%, respectively, p = 0.55). After the 9-month intervention, mammogram adherence was higher in the intervention group compared with the control group (87% vs. 76%, respectively, p