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Improving follow‐up to abnormal breast cancer screening in an urban population
Author(s) -
Battaglia Tracy A.,
Roloff Kathryn,
Posner Michael A.,
Freund Karen M.
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22354
Subject(s) - medicine , breast cancer , logistic regression , population , intervention (counseling) , health care , odds ratio , family medicine , underinsured , medical record , public health , emergency medicine , cancer , gerontology , health insurance , environmental health , nursing , economics , economic growth
Delays in follow‐up after cancer screening contribute to racial/ethnic disparities in cancer outcomes. We evaluated a patient navigator intervention among inner‐city women with breast abnormalities. A full‐time patient navigator supported patients using the care management model. Female patients 18 years and above, referred to an urban, hospital‐based, diagnostic breast health practice from January to June 2000 (preintervention) and November 2001 to February 2003 (intervention), were studied. Timely follow‐up was defined as arrival to diagnostic evaluation within 120 days from the date the original appointment was scheduled. Data were collected via computerized registration, medical records, and patient interview. Bivariate and multivariate logistic regression analyses were conducted, comparing preintervention and intervention groups, with propensity score analysis and time trend analysis to address the limitations of the pre–post design. 314 patients were scheduled preintervention; 1018, during the intervention. Overall, mean age was 44 years; 40% black, 36% non‐Hispanic white, 14% Hispanic, 4% Asian, 5% other; 15% required an interpreter; 68% had no or only public insurance. Forty‐four percent of referrals originated from a community health center, 34% from a hospital‐based practice. During the intervention, 78% had timely follow‐up versus 64% preintervention ( P < .0001). In adjusted analyses, women in the intervention group had 39% greater odds of having timely follow‐up (95% CI, 1.01–1.9). Timely follow‐up in the adjusted model was associated with older age ( P = .0003), having private insurance ( P = .006), having an abnormal mammogram ( P = .0001), and being referred from a hospital‐based practice, as compared to a community health center ( P = .003). Our data suggest a benefit of patient navigators in reducing delay in breast cancer care for poor and minority populations. Cancer 2007. © 2006 American Cancer Society.