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

Prev Med. 2007 Jan;44(1):26-33. doi: 10.1016/j.ypmed.2006.08.001. Epub 2006 Sep 8.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acculturation
  • Adult
  • Aged
  • Algorithms
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / prevention & control*
  • Breast Neoplasms / psychology
  • Case Management*
  • European Continental Ancestry Group / psychology
  • Female
  • Follow-Up Studies
  • Health Knowledge, Attitudes, Practice
  • Hispanic Americans / psychology
  • Humans
  • Los Angeles
  • Mammography* / psychology
  • Middle Aged
  • Minority Groups* / psychology
  • Patient Acceptance of Health Care* / psychology
  • Patient Education as Topic*
  • Patient Satisfaction
  • Poverty / psychology
  • Referral and Consultation*
  • Retrospective Studies
  • Urban Population*