title: Patient perspectives of clinical care and patient navigation in follow-up of abnormal mammography.
abstract: BACKGROUND
  Racial and ethnic disparities in cancer care and survival are well documented. Patient navigation has been shown to improve timely follow-up of abnormal breast screenings for underserved patients. Few studies showed the impact of navigation on patient experiences of care.
  
  
  OBJECTIVE
  We compared the experiences of patients enrolled in a patient navigator program and non-navigated patients referred to a hospital breast center for follow-up of abnormal mammogram in an underserved community health center population.
  
  
  METHODS
  Group comparison study using data from a mail and telephone survey to measure the experience of navigated and non-navigated patients.
  
  
  METHODS
  English- and Spanish-speaking patients with abnormal mammography attending the Avon Breast Center between April 1, 2005 and April 30, 2007. Seventy-two navigated patients and 181 non-navigated patients completed surveys; the survey response rate was 53.6%.
  
  
  METHODS
  Timeliness of care, preparation for the visit to the breast center, ease of access, quality of care, provider communication, unmet need and patient satisfaction.
  
  
  RESULTS
  Most measures of the patient experience did not differ between navigated and non-navigated patients. Overall quality of care was rated as excellent (55% vs 62%, p = 0.294). Navigated patients were significantly more likely than non-navigated to 'definitely' understand what to expect at their visit (79% vs 60%, p = 0.003), to receive a reminder letter or telephone call (89% vs 77%, p = 0.029), and to feel welcome (89% vs 75%, p = 0.012). Navigated patients were less likely than non-navigated to rate the concern shown for their cultural/religious beliefs as excellent (45% vs 54%, p = 0.014).
  
  
  CONCLUSIONS
  Assessing patient perspectives is essential to evaluate the success of quality improvement interventions. In our center, we measured few significant disparities in the perceptions of care of these two very different populations of patients, although, there are still areas in which our program needs improvement. Further research is needed to understand the effectiveness of patient navigation programs in reducing racial and ethnic disparities.
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA. kdonelan@partners.org
authors.forename: Karen
authors.initials: K
authors.lastname: Donelan
authors.forename: Johanna R
authors.initials: JR
authors.lastname: Mailhot
authors.forename: David
authors.initials: D
authors.lastname: Dutwin
authors.forename: Kristen
authors.initials: K
authors.lastname: Barnicle
authors.forename: Sarah Abernethy
authors.initials: SA
authors.lastname: Oo
authors.forename: Karin
authors.initials: K
authors.lastname: Hobrecker
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Chabner
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000208:ethnology*; D003266:Continuity of Patient Care / Q000592:standards; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000592:standards; D006801:Humans; D008327:Mammography / Q000523:psychology* / Q000592:standards; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards; D005791:Patient Care / Q000523:psychology* / Q000592:standards; D017060:Patient Satisfaction / Q000208:ethnology*; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D055815:Young Adult