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- Title
The Addition of Internists to a Breast Health Program.
- Authors
Battaglia, Tracy A.; Howard, Mary Beth; Kavanah, Maureen; Prout, Marianne N.; Chapman, Chava; David, Michele M.; McKinney, Renee; Kronman, Andrea; Dumont, Tara; Freund, Karen M.
- Abstract
With the increases in complexity of care for breast health concerns, there is a growing need for efficient and effective clinical evaluation, especially for vulnerable populations at risk for poor outcomes. The Breast Health Center at Boston Medical Center is a multidisciplinary program, with internists providing care alongside breast surgeons, radiologists, and patient navigators. Using a triage system previously shown to have high provider and patient satisfaction, and the ability to provide timely care, patients are assigned to either a breast surgeon or internist. From 2007 to 2009, internists cared for 2,408 women, representing half of all referrals. Women served were diverse in terms of race (33% black, 30% Hispanic, 5% Asian), language (34% require language interpreter), and insurance status (51% had no insurance or public insurance). Most presented with an abnormal screen (breast examination 54% or imaging 4%) while the remainder were seen for symptoms such as pain (26%), non-bloody nipple discharge (4%), or risk assessment (7%). A majority of final diagnoses were made through clinical evaluation alone ( n = 1,760, 73%), without the need for additional diagnostic imaging or tissue sampling; 9% ( n = 214) received a benign diagnosis with the aid of breast imaging; 19% ( n = 463) required tissue sampling. Only 4% went on to see a breast surgeon. Internists diagnosed 15 incident cancers with a median time to diagnosis of 19 days. Patient and provider satisfaction was high. These data suggest that a group of appropriately trained internists can provide quality breast care to a vulnerable population in a multidisciplinary setting. Replication of this model requires the availability of more clinical training programs for non-surgical providers.
- Subjects
MASSACHUSETTS; BREAST tumor diagnosis; MEDICAL screening evaluation; PATIENT satisfaction; ASIANS; BLACK people; CANCER; HISPANIC Americans; HEALTH insurance; MEDICAL triage; WHITE people; DESCRIPTIVE statistics
- Publication
Breast Journal, 2012, Vol 18, Issue 1, p58
- ISSN
1075-122X
- Publication type
Article
- DOI
10.1111/j.1524-4741.2011.01179.x