Evaluating a patient navigation program in diagnostic breast imaging at a safety-net hospital

Background:  Black women are more likely to die from breast cancer compared to White women.  There are many potential causes of this disparity ranging from lack of information about breast health to limited access to quality breast health services.  Patient navigation has been proven effective in both experimental and observational studies in receipt of timely follow-up.  A core element for most navigation programs is eliminating barriers for patients seeking care.

Methods:  Two full time lay community health workers who have been extensively trained in breast health navigate women who have had an abnormal mammogram to the completion of physician recommended follow-up which includes diagnostic mammograms, ultrasounds and biopsies.  Women with a cancer diagnosis are also navigated to treating physicians. Navigators schedule appointments, obtain referrals and prior films, make reminder calls, provide education about next steps, and among many other activities, provide social support during a time of uncertainty.  We gather data on activities performed needed to complete follow-up imaging, in addition to imaging data abstracted from the electronic medical record.

Results:  In 2013, it took 36 days from the initial abnormal mammogram to initiate needed follow-up, 47 days to become diagnosed with breast cancer and 46 more days to start treatment, all of which can be compared to a 60 day goal set by the state, a target that has been met for several years.  Additionally, only 84% initiated follow-up, indicating that 16% of women with abnormal mammograms had no documented follow-up.  This finding is higher than our goal of having <10% of women with abnormal mammograms lost to follow-up.  We had 10,660 encounters with patients.  The main activities are:  explaining exam results/next steps (29%), scheduling appointments (19%), providing education (11%), and escorting patients (11%). 

Conclusions:  Navigators are effective at assisting women with completing their follow-up in a timely manner.  There may be a relationship between follow-up rates and the volume of abnormal mammograms.  Navigator spends about 20 minutes with each patient they encounter.   They are enormously helpful to both clinicians and patients as they are the breast health resource.  In addition, resolving barriers facing patients to ensure follow-up care can be completed is critical to a timely diagnosis and treatment.  As are other types of community health workers, navigators are well suited to be health promoters in many disease areas and have been incorporated at this safety-net hospital for chronic disease management, HIV linkage to care and diabetes care.