Journal of General Internal Medicine

, Volume 19, Issue 4, pp 316–323

Communication factors in the follow-up of abnormal mammograms

  • Eric G. Poon
  • Jennifer S. Haas
  • Ann Louise Puopolo
  • Tejal K. Gandhi
  • Elisabeth Burdick
  • David W. Bates
  • Troyen A. Brennan
Original Articles

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 

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References

  1. 1.
    Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.Google Scholar
  2. 2.
    Fischer G, Fetters MD, Munro AP, Goldman EB. Adverse events in primary care identified from a risk-management database. J Fam Pract. 1997;45:40–6.PubMedGoogle Scholar
  3. 3.
    Gandhi TK, Burstin HR, Cook EF, et al. Drug complications in outpatients. J Gen Intern Med. 2000;15:149–54.PubMedCrossRefGoogle Scholar
  4. 4.
    Kravitz RL, Rolph JE, Petersen L. Omission-related malpractice claims and the limits of defensive medicine. Med Care Res Rev. 1997;54:456–71.PubMedCrossRefGoogle Scholar
  5. 5.
    Risk Management Foundation. Reducing Office Practice Risks. Forum 20(2) 2000.Google Scholar
  6. 6.
    Leape LL. Error in medicine. J Am Med Assoc. 1994;272:1851–7.CrossRefGoogle Scholar
  7. 7.
    Billings JA, Stoeckle JD. The Clinical Encounter: A Guide to the Medical Interview and Case Presentation. 2nd ed. St. Louis, Mo: Mosby-Year Book; 1999.Google Scholar
  8. 8.
    Varas X, Leborgne JH, Leborgne F, Mezzera J, Jaumandreu S. Revisiting the mammographic follow-up of BI-RADS category 3 lesions. Am J Roentgenol. 2002;179:691–5.Google Scholar
  9. 9.
    Lacquement MA, Mitchell D, Hollingsworth AB. Positive predictive value of the Breast Imaging Reporting and Data System. J Am Coll Surg. 1999;189:34–40.PubMedCrossRefGoogle Scholar
  10. 10.
    Liberman L, Abramson AF, Squires FB, Glassman JR, Morris EA, Dershaw DD. The breast imaging reporting and data system. Positive predictive value of mammographic features and final assessment categories. Am J Roentgenol. 1998;171:35–40.Google Scholar
  11. 11.
    Sickles EA. Probably benign breast lesions: when should follow-up be recommended and what is the optimal follow-up protocol? Radiology. 1999;213:11–4.PubMedGoogle Scholar
  12. 12.
    Smith B. Algorithms for management of common breast complaints. Forum: Risk Manage Foundation. July 1995;1–5.Google Scholar
  13. 13.
    Committee on Gynecologic Practice. ACOG committee opinion. Follow-up of abnormal screening mammography. Int J Gynaecol Obstet. 2002;78:93.CrossRefGoogle Scholar
  14. 14.
    Sickles EA. Periodic mammographic follow-up of probably benign lesions. Results of 3,184 consecutive cases. Radiology. 1991;179:463–8.PubMedGoogle Scholar
  15. 15.
    Chang SW, Kerlkiowske K, Napoles-Springer A, Posner SF, Sickles EA, Perez-Stable EJ. Racial differences in timeliness of follow-up after abnormal screening mammography. Cancer. 1996;78:1395–1402.PubMedCrossRefGoogle Scholar
  16. 16.
    Bryant H. How should we interpret noncompliance with screening mammography? CMAJ. 1996;154:1353–5.PubMedGoogle Scholar
  17. 17.
    Porter-Steele N. Breast pain causes noncompliance with mammography and self-examination. CMAJ. 1996;155:632–3.PubMedGoogle Scholar
  18. 18.
    Kerlikowske K. Timeliness of follow-up after abnormal screening mammography. Breast Cancer Res Treat. 1996;40:52–64.CrossRefGoogle Scholar
  19. 19.
    Strzelczyk JJ, Dignan MB. Disparities in adherence to recommended followup on screening mammogram: interaction of sociodemographic factors. Ethn Dis. 2002;12:77–86.PubMedGoogle Scholar
  20. 20.
    McCarthy BD, Yood MU, Janz NK, Boohaker EA, Ward RE, Johnson CC. Evaluation of factors potentially associated with inadequate follow-up of mammographic abnormalities. Cancer. 1996;77:5–15.CrossRefGoogle Scholar
  21. 21.
    Murff HJ, Bates DW. Notifying patients of abnormal results. In: Shojania KG, Duncan BW, McDonald KM, Wachter RB, Markowitz AJ, eds. Evidence Report/Technology Assessment Number 43. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. July 20, 2001. Available at: http://www.ahrg.gov/clinic/ptsafety. Accessed March 9, 2004.Google Scholar
  22. 22.
    Haas JS, Cook EF, Puopolo AL, Burstin HR, Brennan TA. Differences in the quality of care for women with an abnormal mammogram or breast complaint. J Gen Intern Med. 2000;15:321–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Solomon CG, Goel PK, Larsen PR, Tanasijevic M, Bates DW. Thyroid function testing in an ambulatory setting: identifying suboptimal patterns of use. J Gen Intern Med. 1996;11(suppl):88.Google Scholar
  24. 24.
    Burstin HR, Cook EF, Puopolo AL, Brennan TA. Follow-up of test results in primary care: an opportunity to reduce errors. J Gen Intern Med. 1998;13(suppl).Google Scholar
  25. 25.
    Marcus AC, Kaplan CP, Crane LA, et al. Reducing loss-to-follow-up among women with abnormal Pap smears. Results from a randomized trial testing an intensive follow-up protocol and economic incentives. Med Care. 1998;36:397–410.PubMedCrossRefGoogle Scholar
  26. 26.
    Meza JP, Webster DS. Patient preferences for laboratory test results notification. Am J Manag Care. 2000;6:1297–300.PubMedGoogle Scholar
  27. 27.
    Murff HJ, Gandhi TK, Karson AK, et al. Primary care physician attitudes concerning follow-up of abnormal test results and ambulatory decision support systems. Int J Med Inf. 2003;71:137–49.CrossRefGoogle Scholar
  28. 28.
    Agency for Health Care Research and Quality. 20 Tips to Help Prevent Medical Errors. Patient Fact Sheet. AHRQ Publication No. 00-PO38. Rockville, Md; 2000.Google Scholar
  29. 29.
    Davidoff F. Time. Ann Intern Med. 1997;127:483–5.PubMedGoogle Scholar
  30. 30.
    Anonymous. Health Literacy. Report of the Council on Scientific Affairs. JAMA. 1999;281:552–7.Google Scholar
  31. 31.
    Doak CC, Doak LG, Root JH. Teaching Patients with Low Literacy Skills. 2nd ed. Baltimove, Md: Lippincott Williams & Wilkins; 1996.Google Scholar
  32. 32.
    Mayeaux EJ Jr, Murphy PW, Arnold C, et al. Improving patient education for patients with low literacy skills. Am Fam Physician. 1996;53:205–11.PubMedGoogle Scholar
  33. 33.
    Leape LL. Promoting patient safety by preventing medical error. J Am Med Assoc. 1998;280:1444–7.CrossRefGoogle Scholar
  34. 34.
    Reason J. Organizational Accidents: The Management of Human and Organizational Factors in Hazardous Technologies. Cambridge, England: Cambridge University Press; 1997.Google Scholar
  35. 35.
    Priyanath A, Feinglass J, Dolan NC, Haviley C, Venta LA. Patient satisfaction with the communication of mammographic results before and after the Mammography Quality Standards Reauthorization Act of 1998. Am J Roentgenol. 2002;178:451–6.Google Scholar

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Eric G. Poon
    • 1
  • Jennifer S. Haas
    • 1
  • Ann Louise Puopolo
    • 1
  • Tejal K. Gandhi
    • 1
  • Elisabeth Burdick
    • 1
  • David W. Bates
    • 1
    • 2
  • Troyen A. Brennan
    • 1
    • 2
  1. 1.the Division of General Medicine and Primary Care, Department of MedicineBrigham and Women’s HospitalBoston
  2. 2.Department of Health Policy and ManagementHarvard School of Public HealthBoston

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