Case management appears to be associated with more appropriate follow-up and shorter time to diagnostic resolution among low-income women who receive an abnormal result on a mammogram, according to a report in the March 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Rebecca Lobb, Sc.D., M.P.H., of the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, and colleagues studied 2,252 participants in the National Breast and Cervical Cancer Early Detection Program, which funds breast cancer screening and diagnostic services for low-income, underinsured women. Case management was implemented into this program in 2001 to address barriers to follow-up care after abnormal mammograms, and free treatment was introduced in 2004.
Among women enrolled in the program between 1998 and 2007, the proportion experiencing a delay before diagnosis decreased from 33 percent to 23 percent after the implementation of case management, a risk reduction of 45 percent that did not differ by race or ethnicity. However, case management was not associated with changes in treatment delay. In addition, free treatment was not associated with the risk of delays in either diagnosis or treatment beyond the improvement associated with case management.
"Case management to assist women in overcoming logistic and psychosocial barriers to care may improve time to diagnosis among low-income women who receive free breast cancer screening and diagnostic services," the authors conclude. "Programs that provide services to coordinate care, in addition to free screening and diagnostic tests, may improve population health."
Arch Intern Med. 2010;170. doi:10.1001/archinternmed.2010.22