Patient navigation and case management following an abnormal mammogram: A randomized clinical trial
Patient navigation and case management following an abnormal mammogram: A randomized clinical trial
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DOI：
10.1016/j.ypmed.2006.08.001
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发表时间：
2007-01-01
影响因子：
5.1
通讯作者：
Xie, Bin
中科院分区：
文献类型：
--
作者：
Ell, Kathleen;Vourlekis, Betsy;Xie, Bin
背景低收入的少数民族妇女在乳房X光检查异常后推迟或不遵守预约的比例很高。本研究旨在测试结构化咨询和患者导航干预在大型公共部门医疗中心提高随访率的有效性。这项随机临床试验于2001-2002年在洛杉矶进行，纳入了204名乳房X线检查异常的妇女，这些妇女随后被分配接受干预或常规护理。主要结果是通过8个月内诊断解决的随访率。干预措施导致通过诊断解决方案坚持随访的比例显着增加。干预组通过诊断解决的依从性比对照组更高（90% vs. 66%，OR = 4.48，p < 0.001），并且比UC患者更有可能及时依从（77% vs. 57%，OR = 2.5，p = 0.01）。干预效果没有显着差异分配到不同级别的服务强度的妇女。由结构化临床算法驱动的患者导航和咨询是提高低收入、少数民族乳腺X线异常女性诊断分辨率随访的高效策略。干预算法和可用的培训材料可以适用于为高危妇女服务的各种护理系统，以减少随访损失。(c)2006年爱思唯尔公司All rights reserved.
Background. A high rate of low-income, ethnic minority women delay or fail to keep appointments following abnormal mammograms. This study was designed to test the effectiveness of a structured counseling and patient navigation intervention for improving follow-up rates at a large public sector medical center.Methods. This randomized clinical trial, conducted in Los Angeles 2001-2002, included 204 women with abnormal mammograms referred for follow-up who were then assigned to intervention or usual care. The primary outcome was the rate of follow-up through diagnostic resolution within eight months.Results. The intervention resulted in a significant increase in the rate of adherence to follow-up through diagnostic resolution. The intervention group was much more likely to be adherent through diagnostic resolution than the control group (90% vs. 66%, OR = 4.48, p < 0.001) and were more likely to experience timely adherence than UC patients (77% vs. 57%, OR = 2.5, p = 0.01). Intervention effectiveness was not significantly different for women assigned to different levels of service intensity.Conclusions. Patient navigation and counseling driven by a structured clinical algorithm are highly effective strategies to improve diagnostic resolution follow-up among low-income, ethnic minority women with abnormal mammograms. The intervention algorithm and available training materials can be adapted for diverse care systems serving high-risk women to decrease loss to follow-up. (c) 2006 Elsevier Inc. All rights reserved.