title: The addition of internists to a breast health program.
abstract: With the increases in complexity of care for breast health concerns, there is a growing need for efficient and effective clinical evaluation, especially for vulnerable populations at risk for poor outcomes. The Breast Health Center at Boston Medical Center is a multidisciplinary program, with internists providing care alongside breast surgeons, radiologists, and patient navigators. Using a triage system previously shown to have high provider and patient satisfaction, and the ability to provide timely care, patients are assigned to either a breast surgeon or internist. From 2007 to 2009, internists cared for 2,408 women, representing half of all referrals. Women served were diverse in terms of race (33% black, 30% Hispanic, 5% Asian), language (34% require language interpreter), and insurance status (51% had no insurance or public insurance). Most presented with an abnormal screen (breast examination 54% or imaging 4%) while the remainder were seen for symptoms such as pain (26%), non-bloody nipple discharge (4%), or risk assessment (7%). A majority of final diagnoses were made through clinical evaluation alone (n = 1,760, 73%), without the need for additional diagnostic imaging or tissue sampling; 9% (n = 214) received a benign diagnosis with the aid of breast imaging; 19% (n = 463) required tissue sampling. Only 4% went on to see a breast surgeon. Internists diagnosed 15 incident cancers with a median time to diagnosis of 19 days. Patient and provider satisfaction was high. These data suggest that a group of appropriately trained internists can provide quality breast care to a vulnerable population in a multidisciplinary setting. Replication of this model requires the availability of more clinical training programs for non-surgical providers.
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Women's Health Unit, and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA 02118, USA. Tracy.Battaglia@bmc.org
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Howard
authors.forename: Maureen
authors.initials: M
authors.lastname: Kavanah
authors.forename: Marianne N
authors.initials: MN
authors.lastname: Prout
authors.forename: Chava
authors.initials: C
authors.lastname: Chapman
authors.forename: Michele M
authors.initials: MM
authors.lastname: David
authors.forename: Renee
authors.initials: R
authors.lastname: McKinney
authors.forename: Andrea
authors.initials: A
authors.lastname: Kronman
authors.forename: Tara
authors.initials: T
authors.lastname: Dumont
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003954:Diagnostic Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007388:Internal Medicine / Q000193:education; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D017060:Patient Satisfaction; D014218:Triage; D014932:Women's Health Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult