ABSTRACT
BACKGROUND: Barriers to assessing a patient's risk for breast cancer include the inadequate documentation of family history, the complexity of risk calculation and model selection, and a lack of awareness of risk on the part of the patient and/or provider. We have established computer-based, real-time assessment of a patient's risk for breast cancer at the time of having a mammogram. OBJECTIVE: To facilitate identifcation of high-risk patients who need genetic counseling and testing and magnetic resonance imaging screening based on the results of the risk assessment. METHODS: Since November 23, 2010, all mammogram patients have completed questionnaires using a wireless tablet. On the basis of a real-time calculation for a patient's risk of BRCA1/BRCA2 mutation (Myriad, Tyrer-Cuzick, BRCAPRO) and lifetime risk of breast cancer (Gail, Claus, Tyrer-Cuzick, BRCAPRO) using Hughes riskApps, patients were categorized as high risk (≥ 10% BRCA mutation or ≥ 20% lifetime breast cancer risk) or average risk and received a risk assessment letter. The risk data was integrated into our mammography information system (PenRad) at the same time. High-risk patients were contacted to facilitate evaluation. RESULTS: As of June 30, 2012, a total of 24,213 unaffected patients completed the risk assessment. There were 2,196 patients (9.1%) identifed as high risk: 1,051 (4.3%) had a BRCA mutation risk, 1,570 (6.5%) had lifetime breast cancer risk, and 425 (1.8%) had risk for both. Of the high-risk patients, 416 (18.7%) were evaluated by our APN and/or genetic counselor. Of the 231 who were evaluated by a genetic counselor, 97 had genetic testing and 9 (8.3%) were BRCA positive. Annual MRI screening was recommended to 254 patients. CONCLUSIONS: We have successfully implemented breast cancer risk assessment through our screening mammography service. Results suggest that 9.1% of our patients can beneft from risk assessment, 4.3% should consider genetic testing, and 6.5% may benefit from screening MRI. We strive to improve compliance through patient education.
ABSTRACT
Difficult transition from acute hospital back to the community can be challenging. Problems encountered during this process can lead to unplanned readmission and emergency department visits. It is important for care managers to be able to identify patients susceptible to difficult transition and to understand strategies to reduce risk of unplanned hospital readmission. This qualitative systematic review of 10 studies of discharge interventions and patient characteristics finds little evidence that enhanced discharge support is related to improved physical status at home, but there is mixed support for its role in preventing or delaying hospital readmissions in certain discharge diagnoses, specifically heart failure and stroke. Additionally, those with adequate social support and confidence in their self-care ability tend to experience fewer readmissions than do those living alone and those who perceive themselves as not ready to return home.
