title: Patient navigation to improve follow-up of abnormal mammograms among disadvantaged women.
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.
authors.affiliation: 1 Chelsea HealthCare Center, Massachusetts General Hospital , Chelsea, Massachusetts.
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ashburner
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: McCarthy
authors.forename: Sorbarikor
authors.initials: S
authors.lastname: Piawah
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003151:Community Health Centers; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D008404:Massachusetts; D008507:Medically Underserved Area; D008875:Middle Aged; D062526:Patient Navigation; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D016016:Proportional Hazards Models; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D035862:Vulnerable Populations