"Patient Navigation in the SafetyNet: CONNECTeDD"

描述(由申请人提供)： 尽管在早期发现和治疗方案方面取得了进展，但少数族裔和社会经济地位较低的妇女在确诊时仍处于晚期，乳腺癌和宫颈癌的死亡率较高。诊断和治疗的延误会导致较差的结果，这与众所周知的护理障碍有关。尽管如此，这些差距仍然存在，尽管知识表明癌症治疗的发现和提供之间存在差距，因此迫切需要有效的干预措施。 本研究的目标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器干预。这些网站代表了广泛的种族/少数民族和社会经济地位较低的妇女，由一个反映该国城市卫生系统基础设施的城市安全网机构提供服务。该干预措施是基于安徒生的卫生服务使用模式。借助电子病历跟踪系统和基于理论的文化能力培训，患者导航员将：识别病例、提供服务协调和指导患者支持。 我们的具体目标是确定干预是否会： 1.减少异常乳房X光检查或巴氏涂片后的诊断时间(或异常情况的解决)；2.减少癌症诊断后完成治疗的时间，并提供更高质量的治疗；3.提高患者对医疗服务的满意度；4.拥有推动其成功的关键组成部分(与患者在一起的时间与时间协调的护理)；5.产生更具成本效益的护理。 我们将采用准实验设计，对六个主要附属于波士顿医疗中心的社区卫生中心进行随机区组设计。每个站点将被随机分配到乳房或宫颈患者导航。因此，每个乳房干预点将作为宫颈干预点的连续比较点，反之亦然。 我们希望这项研究的结果将有助于设计一种可推广的标准、有效和成本效益高的患者导航模式，从而消除种族/少数民族和低收入人群中及时、高质量的癌症护理的障碍。

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