Communication factors in the follow-up of abnormal mammograms
10.1111/j.1525-1497.2004.30357.x Cite this article as: Poon, E.G., Haas, J.S., Puopolo, A.L. et al. J GEN INTERN MED (2004) 19: 316. doi:10.1111/j.1525-1497.2004.30357.x Abstract OBJECTIVE: To identify the communication factors that are significantly associated with appropriate short-term follow-up of abnormal mammograms. DESIGN: Prospective longitudinal study involving medical record review and patient survey. SETTING: Ten academically affiliated ambulatory medical practices in the Boston metropolitan area. PARTICIPANTS: One hundred twenty-six women with abnormal mammograms requiring short-term (6 months) follow-up imaging. MEASUREMENTS: Proportion of women in the study who received appropriate follow-up care. RESULTS: Eighty-one (64%) of the women with abnormal mammograms requiring short-term follow-up imaging received the appropriate follow-up care. After adjusting for patients’ age and insurance status, 2 communication factors were found to be independently associated with the delivery of appropriate follow-up care: 1) physicians’ documentation of a follow-up plan in the medical record (adjusted odds ratio, 2.79; 95% confidence interval, 1.11 to 6.98; P=.029); and 2) patients’ understanding of the need for follow-up (adjusted odds ratio, 3.86; 95% confidence interval, 1.50 to 9.96; P=.006). None of the patients’ clinical or psychological characteristics were associated with the delivery of appropriate follow-up care. CONCLUSIONS: Follow-up care for women with abnormal mammograms requiring short-term follow-up imaging is suboptimal. Documentation of the follow-up plan by the physician and understanding of the follow-up plan by the patient are important factors that are correlated with the receipt of appropriate follow-up care for these women. Interventions designed to improve the quality of result follow-up in the outpatient setting should address these issues in patient-doctor communication. Key words test result follow-up abnormal mammogram patient-doctor communication patient safety quality improvement
This power calculation assumes 1) a 34 to 66 distribution in the risk factor of interest, and 2) the group without the risk factor had a 0.4 probability for receiving adequate follow-up and the group with the risk factor had a 0.6 probability of receiving adequate follow-up.
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