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BMC Health Services Research

, 13:314

Quality, performance, safety and outcomes

Abstract

BackgroundProstate cancer disproportionately affects low-income and minority men. This study evaluates the impact of a patient navigation intervention on timeliness of diagnostic resolution and treatment initiation among veterans with an abnormal prostate cancer screen.

MethodsParticipants were enrolled between 2006 and 2010. The intervention involved a social worker and lay health worker navigation team that assisted patients in overcoming barriers to care. For navigated n = 245 versus control n = 245 participants, we evaluated rates of diagnostic resolution and treatment and adjusted for race, age, and Gleason score.

ResultsOf 490 participants, 68% were African American, 47% were ≥ 65 years old, and 35% had cancer. Among those with an abnormal screen, navigation did not have a significant effect on time to diagnostic resolution compared to controls median days of 97 versus 111; adj. HR 1.17, 95% CI, 0.96-1.43, p = 0.12. On analysis of the period beyond 80 days, navigated men reached resolution faster than controls median of 151 days versus 190 days; adj. HR 1.41, 95% CI, 1.07-1.86, p = 0.01. Among those with cancer, navigation did not have a significant effect on time to treatment initiation compared to controls median of 93 days versus 87 days; adj. HR 1.15, 95% CI, 0.82-1.62, p = 0.41.

ConclusionOur navigation program did not significantly impact the overall time to resolution or treatment for men with prostate cancer compared to controls. The utility of navigation programs may extend beyond targeted navigation times, however, and future studies focusing on other outcomes measures are therefore needed.

AbbreviationsDREDigital rectal exam

NCINational Cancer Institute

ACSAmerican Cancer Society

PNRPPatient Navigation Research Program

VAVeterans Affairs

PSAProstate specific antigen

IRBInstitutional Review Board

TRUSTransrectal ultrasound

HRHazard ratio

HRHazard ratio

CCICharlson Comorbidity Index.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-314 contains supplementary material, which is available to authorized users.

Melissa A Simon, Narissa J Nonzee contributed equally to this work.

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Autor: Melissa A Simon - Narissa J Nonzee - June M McKoy - Dachao Liu - Thanh Ha Luu - Peter Byer - Elizabeth A Eklund - Eliz

Fuente: https://link.springer.com/







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