"Patient Navigation in the SafetyNet: CONNECTeDD"

描述（由申请人提供）： 尽管在早期发现和治疗选择方面取得了进展，但少数种族/族裔和社会经济地位低的妇女在诊断乳腺癌和宫颈癌时仍然处于晚期，死亡率较高。诊断和治疗的延误导致了较差的结果，与众所周知的护理障碍有关。这些差异持续存在，尽管这种知识代表了发现和提供癌症护理之间的差距，导致迫切需要有效的干预措施。 本研究的目的是在马萨诸塞州波士顿的六个社区卫生中心设计、实施和评估患者导航员干预。这些网站代表了广泛的种族/少数民族和社会经济地位低下的妇女，她们得到城市安全网机构的服务，该机构反映了该国城市卫生系统的基础设施。干预是基于Andersen的卫生服务使用模式的一种模式。在电子病历跟踪系统和基于理论的文化能力培训的帮助下，患者导航员将：识别病例，提供服务协调和直接患者支持。 我们的具体目标是确定干预是否会： 1.减少乳房X光检查或巴氏涂片检查异常后的诊断时间（或异常解决）; 2.缩短完成治疗的时间，并在癌症诊断后提供更高质量的治疗; 3.提高患者对医疗服务的满意度; 4.具有推动其成功的关键组成部分（与患者的时间与协调护理的时间）; 5.提供更具成本效益的护理。 我们将采用准实验设计，对主要隶属于波士顿医疗中心的六个社区卫生中心进行区组随机化。每家临床试验机构将被随机分配到乳腺或宫颈患者导航组。因此，每个乳房介入部位将作为宫颈介入部位的连续比较部位，反之亦然。 我们希望本研究的结果将为设计一个可推广的标准、有效和具有成本效益的患者导航模型提供信息，该模型将消除种族/少数民族和低收入人群中及时、高质量癌症护理的障碍

DESCRIPTION (provided by applicant): Despite advances in early detection and treatment options, racial/ethnic minority and low socioeconomic status women continue to suffer advanced stage at diagnosis and higher mortality for both breast and cervical cancer. Delays in diagnosis and treatment, which contribute to poorer outcomes, have been associated with well known barriers to care. These disparities persist despite this knowledge represents a gap between discovery and delivery of cancer care resulting in a pressing need for effective interventions. The objective of this study is to design, implement and evaluate a patient navigator intervention at six community health centers in Boston, Massachusetts. These sites represents a wide range of racial/ethnic minority and low socioeconomic status women served by an urban safety net institution that mirrors the infrastructure of this country's urban health systems. The intervention is a model based on Andersen's Model of Health Services Use. Aided by an Electronic Medical Record tracking system and theory based cultural competency training, patient navigators will: identify cases, provide service coordination and direct patient support. Our specific aims are to determine if the intervention will: 1. Reduce time to diagnosis (or resolution of abnormality) after an abnormal mammogram or Pap smear; 2. Reduce time to complete treatment and provide higher quality treatment after a cancer diagnosis; 3. Improve patient satisfaction with health care services; 4. Have critical components (time with patient vs. time coordinating care) which drive its success; 5. Result in more cost-effective care. We will use a quasi-experimental design with block randomization of six community health centers whose primary affiliation is with Boston Medical Center. Each site will be randomly assigned to either Breast or Cervical Patient Navigation. Thus, each of the Breast intervention sites will serve as a continuous comparison site for the Cervical intervention sites and vice versa. We expect that the results of this study will inform the design of a generalizable standard, effective and cost efficient patient navigation model that will eliminate barriers to timely, quality cancer care among racial/ethnic minority and lower income populations