Abstract CN03-04: Improving follow-up to abnormal breast cancer screening in an urban population: A patient navigation intervention
Abstract CN03-04: Improving follow-up to abnormal breast cancer screening in an urban population: A patient navigation intervention
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摘要 CN03-04：改善城市人群异常乳腺癌筛查的随访：患者导航干预
DOI：
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发表时间：
2010
期刊：
影响因子：
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通讯作者：
K. Freund
中科院分区：
文献类型：
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作者：
T. Battaglia;A. Kronman;K. Beaver;K. Freund
背景资料：在少数民族和低收入妇女中，乳腺癌筛查试验异常后，延迟和/或缺乏后续行动，导致乳腺癌发病率和死亡率增加。目的：评估患者导航干预对在内城学术医疗中心寻求护理的女性及时诊断随访依从率的影响;并制定持续的质量改进指标，以纵向监测其成功并确定最佳实践。设计：质量改进干预与历史对照组。及时随访定义为自首次计划诊断预约日期起120天内到达诊断评价。通过计算机化登记、医疗记录和患者访谈收集数据。进行双变量和多变量logistic回归分析，比较干预前和干预组，倾向评分分析和时间趋势分析，以解决前后设计的局限性。创建了以下持续质量改进指标，以纵向监控计划的成功：导航联系人级别的长期趋势、导航联系人级别的预约完成率的长期趋势以及逻辑回归，以评估导航联系人级别在数月内完成预约的几率。研究对象：2000年1月至6月（干预前）、2001年11月至2003年2月（干预）和2007年1月至2009年6月（干预），所有妇女都在市中心的学术安全网机构接受乳房健康诊断。干预措施：患者导航员接受培训，以确定个别患者获得护理的障碍，并与提供者团队合作，通过将患者与可用资源联系起来来克服这些障碍。两名全职导航员被整合到诊断提供者团队中，并直接与患者、提供者和放射科互动，以协调和确保及时跟进推荐的护理。导航员通过电话、亲自拜访和提醒信等方式与患者互动。导航员遵守外联协议，并利用电子报告跟踪受试者。关键结果：314例患者在干预前进行了计划，1，018例患者在初始干预期间进行了计划。总体而言，平均年龄为44岁; 40%为黑人，36%为非西班牙裔白色，14%为西班牙裔，4%为亚裔，5%为其他; 15%需要翻译; 68%没有或只有公共保险。44%的转诊来自社区卫生中心，34%来自医院。在干预期间，78%的患者及时随访，而干预前为64%（P结论：我们的数据记录了患者导航员在减少贫困和少数民族乳腺癌护理延迟方面的益处，并提出了纵向监测计划成功的最佳实践。开发和利用导航有效性的措施可以提高护理质量。引文信息：Cancer Prev Res 2010;3（12 Suppl）：CN 03 -04。
Background: Delays and/or lack of follow up after an abnormal breast cancer screening test among minority and low-income women contribute to increased morbidity and mortality from breast cancer. Objective: To evaluate the effect of a patient navigation intervention on adherence rates to timely diagnostic follow up among women seeking care at an inner city academic medical center; and to develop ongoing quality improvement metrics to monitor its success longitudinally and determine best practices. Design: Quality improvement intervention with an historical control group. Timely follow-up was defined as arrival to diagnostic evaluation within 120 days from the first scheduled diagnostic appointment date. Data were collected via computerized registration, medical records, and patient interview. Bivariate and multivariate logistic regression analyses were conducted, comparing preintervention and intervention groups, with propensity score analysis and time trend analysis to address the limitations of the pre-post design. The following continuous quality improvement metrics were created to monitor success of the program longitudinally: secular trend of Navigator Contact Level, secular trend of Appointment Completion Rate by Navigator Contact Level, and logistic regression to evaluate odds of completing appointment within months by Navigator Contact Level. Study Subjects: All women referred to a diagnostic breast health practice at an inner city academic safety-net institution from January to June 2000 (preintervention), November 2001 to February 2003 (intervention), and from January 2007 to June 2009 (intervention). Intervention: Patient navigators are trained to identify individual patient barriers to accessing care and working with the team of providers to overcome those barriers by linking patients to available resources. Two fulltime navigators are integrated into the diagnostic provider team and interacted directly with patients, providers, and radiology to coordinate and ensure timely follow up to recommended care. Navigators interact with patients through a combination of telephone calls, in-person visits and reminder letters. Navigators adhere to protocols for outreach and utilize an electronic report to track subjects. Key Results: 314 patients were scheduled preintervention and 1,018 during the initial intervention period. Overall, mean age was 44 years; 40% were black, 36% non-Hispanic white, 14% Hispanic, 4% Asian, 5% other; 15% required an interpreter; 68% had no or only public insurance. Forty-four percent of referrals originated from a community health center, 34% from a hospital-based practice. During the intervention, 78% had timely follow-up versus 64% preintervention (P Conclusions: Our data document the benefit of patient navigators in reducing delays in breast cancer care for poor and minority populations and suggest best practices for monitoring program success longitudinally. Developing and utilizing measures of navigator effectiveness can improve quality of care. Citation Information: Cancer Prev Res 2010;3(12 Suppl):CN03-04.