Boston Patient Navigation Research Program: the impact of navigation on time to diagnostic resolution after abnormal cancer screening.
Boston Patient Navigation Research Program: the impact of navigation on time to diagnostic resolution after abnormal cancer screening.
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DOI：
10.1158/1055-9965.epi-12-0532
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发表时间：
2012-10
期刊：
影响因子：
--
通讯作者：
Freund KM
中科院分区：
文献类型：
--
作者：
Battaglia TA;Bak SM;Heeren T;Chen CA;Kalish R;Tringale S;Taylor JO;Lottero B;Egan AP;Thakrar N;Freund KM
有必要进行对照研究，以评估患者导航对弱势癌症人群的影响。波士顿患者导航研究计划在六个联邦合格的市中心社区卫生中心进行了准实验性患者导航干预，其中三个被分配到乳腺癌导航干预，三个被分配到宫颈癌导航干预;每组然后作为另一组的对照。符合条件的妇女在基线（2004-2005年）或干预期（2007-2008年）在参与的卫生中心之一进行了异常的乳腺癌或宫颈癌筛查试验。Kaplan-Meier生存曲线和比例风险回归分析了患者导航对确诊时间的影响，调整了协变量，按诊所聚类以及基线和干预期之间的差异。我们在基线期招募了997名受试者，在干预期招募了3，041名受试者，其中导航组1，497名，对照组1，544名。与对照组相比，导航组中宫颈筛查异常的受试者的诊断时间显著缩短（aHR 1.46，95% CI：1.1-1.9）;以及60天后消退的乳腺癌筛查异常患者（aHR 1.40，95% CI：1.1-1.9），60天前无差异。本研究记录了在种族/民族多样化的内城人群中及时进行患者导航以进行诊断的益处。患者导航可以通过减少异常癌症筛查事件后的诊断时间来解决癌症健康差异。
There is a need for controlled studies to assess the impact of patient navigation in vulnerable cancer populations. Boston Patient Navigation Research Program conducted a quasi-experimental patient navigation intervention across six federally qualified inner-city community health centers, three assigned to a breast cancer navigation intervention and three assigned to a cervical cancer navigation intervention; each group then served as the control for the other. Eligible women had an abnormal breast or cervical cancer screening test performed at one of the participating health centers during a baseline (2004–2005) or intervention period (2007–2008). Kaplan-Meier survival curves and proportional hazards regression examined the effect of patient navigation on time to definitive diagnosis, adjusting for covariates, clustering by clinic and differences between the baseline and intervention period. We enrolled 997 subjects in the baseline period and 3,041 subjects during the intervention period, of whom 1,497 were in the navigated arm, and 1,544 in the control arm. There was a significant decrease in time to diagnosis for subjects in the navigated group compared with controls among those with a cervical screening abnormality (aHR 1.46, 95% CI: 1.1–1.9); and among those with a breast cancer screening abnormality who resolved after 60 days (aHR 1.40, 95% CI: 1.1–1.9), with no differences before 60 days. This study documents a benefit of patient navigation on time to diagnosis among a racially/ethnically diverse inner city population. Patient navigation may address cancer health disparities by reducing time to diagnosis following an abnormal cancer screening event.