What to know
The follow-up and referral focus area includes tools and resources to ensure timely referral for diagnostic testing, treatment, and other appropriate next steps (such as genetic testing) when screening tests are abnormal.
Introduction
This page is part of the Breast Cancer Screening Change Package.
Change concepts are "general notions that are useful for developing more specific strategies for changing a process."1 Change ideas are evidence-based or practice-based "actionable, specific ideas or strategies."1 Each change idea is linked to tools and resources that can be used or adapted to improve cancer screening.
Note: See a list of acronyms used in this change package.
Change concept: Establish relationships with specialists for diagnostic testing and treatment.
Identify and partner with referral services or specialists who can provide follow-up diagnostic tests and/or cancer screening.
- IOM — Primary Care and Public Health: Exploring Integration to Improve Population Health
- Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis
Establish two-way communication with referral services or specialists to find out if patients followed up with referrals.
- AHRQ — Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms
- Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis
Change concept: Adopt policies and procedures for patient referral and follow-up for diagnostic testing and treatment.
Develop protocols and workflows, such as reminder systems, to ensure follow-up referrals are made.
- Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis
- The Primary Care Coalition of Montgomery County — Breast Healthcare Improvement in the Safety-Net: Change Package Rapid Innovation to Improve Outcomes
Implement best practices for notification of abnormal test results and follow-up instructions to the patient.
- ACR — Mammography Sample Lay Report LettersA B
- ONC — SAFER: Self-Assessment Test Results Reporting and Follow-Up, pages 5–7
Create a tracking system for documenting patient follow-up after an abnormal test result.
- ACOG — Tracking and Reminder Systems
- ECRI on behalf of HRSA — Using the EHR for Care Management and Tracking
Use EHR-based clinical decision management tools to guide follow-up care.
- ECRI on behalf of HRSA — Using the EHR for Care Management and Tracking
Change concept: Overcome barriers to follow-up and treatment.
Identify sources for low-cost or free transportation services for follow-up care.
- ACS — Road to Recovery [English and Spanish]
- AHA — Social Determinants of Health Series: Transportation and the Role of Hospitals
- CMS — Non-Emergency Medical Transportation (NEMT)
- Livestrong — Transportation and Other Cancer Support Services
Offer same-day and open-access scheduling and services outside of traditional hours.
- The Community Guide — Cancer Screening: Reducing Structural Barriers for Clients – Breast Cancer
Use patient navigation to help individuals access follow-up services.
- Indicates a patient resource.
- This resource may contain some information that does not reflect the current US Preventive Services Task Force recommendations for breast cancer screening.
- Centers for Disease Control and Prevention. Tobacco Cessation Change Package. US Department of Health and Human Services; 2019.