Patient navigation and case management following an abnormal mammogram: A randomized clinical trial

Background. A high rate of low-income, ethnic minority women delay or fail to keep appointments following abnormal mammograms. This study was designed to test the effectiveness of a structured counseling and patient navigation intervention for improving follow-up rates at a large public sector medical center. Methods. This randomized clinical trial, conducted in Los Angeles 2001-2002, included 204 women with abnormal mammograms referred for follow-up who were then assigned to intervention or usual care. The primary outcome was the rate of follow-up through diagnostic resolution within eight months. Results. The intervention resulted in a significant increase in the rate of adherence to follow-up through diagnostic resolution. The intervention group was much more likely to be adherent through diagnostic resolution than the control group (90% vs. 66%, OR = 4.48, p < 0.001) and were more likely to experience timely adherence than UC patients (77% vs. 57%, OR = 2.5, p = 0.01). Intervention effectiveness was not significantly different for women assigned to different levels of service intensity. Conclusions. Patient navigation and counseling driven by a structured clinical algorithm are highly effective strategies to improve diagnostic resolution follow-up among low-income, ethnic minority women with abnormal mammograms. The intervention algorithm and available training materials can be adapted for diverse care systems serving high-risk women to decrease loss to follow-up. (c) 2006 Elsevier Inc. All rights reserved.