Patient navigation and case management following an abnormal mammogram: a randomized clinical trial.
BACKGROUND
A high rate of low-income, ethnic minority women delay or fail to keep appointments following abnormal mammograms. This study was designed to test the effectiveness of a structured counseling and patient navigation intervention for improving follow-up rates at a large public sector medical center.


METHODS
This randomized clinical trial, conducted in Los Angeles 2001-2002, included 204 women with abnormal mammograms referred for follow-up who were then assigned to intervention or usual care. The primary outcome was the rate of follow-up through diagnostic resolution within eight months.


RESULTS
The intervention resulted in a significant increase in the rate of adherence to follow-up through diagnostic resolution. The intervention group was much more likely to be adherent through diagnostic resolution than the control group (90% vs. 66%, OR=4.48, p<0.001) and were more likely to experience timely adherence than UC patients (77% vs. 57%, OR=2.5, p=0.01). Intervention effectiveness was not significantly different for women assigned to different levels of service intensity.


CONCLUSIONS
Patient navigation and counseling driven by a structured clinical algorithm are highly effective strategies to improve diagnostic resolution follow-up among low-income, ethnic minority women with abnormal mammograms. The intervention algorithm and available training materials can be adapted for diverse care systems serving high-risk women to decrease loss to follow-up.
Ell
Kathleen
K
University of Southern California, School of Social Work, USA. ell@usc.edu
Vourlekis
Betsy
B
Lee
Pey-Jiuan
PJ
Xie
Bin
B
D000069:Acculturation; D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D019090:Case Management; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D015141:Los Angeles; D008327:Mammography / Q000523:psychology; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011203:Poverty / Q000523:psychology; D012017:Referral and Consultation; D012189:Retrospective Studies; D014505:Urban Population; D044465:White People / Q000523:psychology