Patient navigation in breast health services: Improving quality of services at a safety net hospital in Chicago

In Chicago, the Black: White breast cancer mortality disparity has been widening. In 1980 the rates were almost identical, but by 2003 the rate ratio was 1.68 resulting from rates of 40.4/100,000 for Blacks and 24.0 for Whites. This 68% disparity is higher than both those for the US (37%) and New York City (17%). Anecdotal reports suggest that one explanation for this large and growing racial disparity might be that Black women receive an inferior quality of breast care. Research suggests that navigation services may improve such quality and such an intervention was implemented at Mount Sinai Hospital in Chicago.

Our program provides navigation services that facilitate follow-up after abnormal findings, provide support during procedures, minimize barriers to making appointments, promote informed decision making on diagnosis and treatment by using uses patient encounters as educational opportunities to reinforce positive health behaviors. Patients are closely followed from abnormal mammogram to a final diagnosis by patient navigators who provide services with transportation assistance, help in obtaining needed referrals, assistance with setting up appointments, provision of translation, guiding patients to and from appointments, and providing emotional support for patients and their families during the diagnosis and treatment process.

We obtained 2005 (baseline) and preliminary 2006 data describing mammography, ultrasound, MRI, pathology and breast cancer diagnoses from the hospital's electronic database. In 2005 the loss to follow-up rate was 33% among women with screening mammograms requiring additional imaging and in 2006 it was 15% (p < 0.001). Among those returning for additional imaging resulting in highly suspicious mammograms the loss to follow-up rate was reduced from 50% in 2005 to 0% in 2006 (p < 0.01). The proportion of women who had a screening mammogram and were treated for breast cancer within 45 days was 34% in 2005 and 50% in 2006 (p > 0.05). Fifty-six percent of breast cancer patients were treated within 30 days after the initial diagnosis in 2006, compared to 48% in 2005 (p > 0.05). These last two findings are not yet significant due to the small number of cancers detected.

The use of a patient navigator in breast health is an effective way to reduce the loss to follow-up and expedite diagnosis and treatment. Navigators promote informed decision making regarding treatment. This improves the quality of care and ultimately will help reduce racial disparities breast health care.