Patient Navigation to Increase Mammography Screening Among Inner City Women

BACKGROUND: Lower mammography screening rates among minority and low income women contribute to increased morbidity and mortality from breast cancer. OBJECTIVE: To evaluate the effect of a patient navigation intervention on adherence rates to biennial screening mammography among women engaged in primary care at an inner-city academic medical center. DESIGN: Quality improvement intervention with a concurrent control group, conducted from February to November of 2008. STUDY SUBJECTS: All women in a hospital-based primary care practice aged 51-70 years. Subjects were randomized at the level of their primary care provider, such that half of the patients in the practice received the intervention, while the other half received usual care. INTERVENTIONS: Intervention subjects whose last mammogram was >18 months prior received a combination of telephone calls and reminder letters from patient navigators trained to identify barriers to care. Navigators were integrated into primary care teams and interacted directly with patients, providers, and radiology to coordinate care. Navigators utilized an electronic report to track subjects. Adherence rates to biennial mammography were assessed in intervention and control groups at baseline and post-intervention. KEY RESULTS: A total of 3,895 women were randomized to intervention ( n=1,817) and control (n=2,078) groups. Mean age was 60, 71% were racial/ethnic minorities, 23% were non-English speaking, and 63% had public or no health insurance. At baseline, there was no difference in mammography adherence between the control and intervention groups (78%, respectively, p=0.55). After the 9-month intervention, mammogram adherence was higher in the intervention group compared with the control group (87% vs. 76%, respectively, p<0.001). Except among Hispanic women who demonstrated high rates in both the intervention and control groups (85% and 83%, respectively), all racial/ethnic and insurance groups demonstrated higher adherence in the intervention group. CONCLUSIONS: Patient navigation improves biennial mammography rates for inner city, low income, minority populations.