The addition of internists to a breast health program.

Publisher: Wiley Country of Publication: United States NLM ID: 9505539 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4741 (Electronic) Linking ISSN: 1075122X NLM ISO Abbreviation: Breast J Subsets: MEDLINE

Publication: 2022- : [Hoboken, New Jersey] : [London] : Hindawi Wiley ;
Original Publication: Cambridge, MA : Blackwell Science, c1995-

Internal Medicine*/education; Breast Neoplasms/*diagnosis ; Diagnostic Services/*organization & administration ; Early Detection of Cancer/*methods ; Patient Care Team/*organization & administration ; Women's Health Services/*organization & administration; Adolescent ; Adult ; Aged ; Attitude of Health Personnel ; Breast Neoplasms/prevention & control ; Diagnostic Services/standards ; Diagnostic Services/statistics & numerical data ; Early Detection of Cancer/standards ; Early Detection of Cancer/statistics & numerical data ; Female ; Humans ; Interdisciplinary Communication ; Middle Aged ; Outcome and Process Assessment, Health Care ; Patient Care Team/standards ; Patient Satisfaction ; Triage ; Women's Health Services/standards ; Women's Health Services/statistics & numerical data ; Young Adult

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.
(© 2011 Wiley Periodicals, Inc.)

Date Created: 20111122 Date Completed: 20120917 Latest Revision: 20191210

20240628

10.1111/j.1524-4741.2011.01179.x

22098389