BACKGROUND: While there is widespread dissemination of patient navigation programs in an effort to reduce delays in cancer care, little is known about the impact of barriers to care on timely outcomes. METHODS: We conducted a secondary analysis of the Boston Patient Navigation Research Program (PNRP) to examine the effect that the presence of barriers had on time to diagnostic resolution of abnormal breast or cervical cancer screening tests. We used multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome to examine the effect of the number of barriers, controlling for demographic covariates and clustered by patients' primary navigator. RESULTS: There were 1481 women who received navigation; mean age was 39 years; 32% were White, 27% Black, and 31% Hispanic; 28% had private health insurance; and 38% did not speak English. Overall, half (n=745, 50%) had documentation of one or more barriers to care. Women with barriers were more likely to be older, non-White, non-English language speakers, and on public or no health insurance compared with women without barriers. In multivariable analyses, we found less timely diagnostic resolution as the number of barriers increased (one barrier, adjusted hazard ratio [aHR] 0.81 [95% CI 0.56-1.17], p=0.26; two barriers, aHR 0.55 [95% CI 0.37-0.81], p=0.0025; three or more barriers, aHR 0.31 [95% CI 0.21-0.46], p<0.0001)]. CONCLUSION: Within a patient navigation program proven to reduce delays in care, we found that navigated patients with documented barriers to care experience less timely resolution of abnormal cancer screening tests.
BACKGROUND: While there is widespread dissemination of patient navigation programs in an effort to reduce delays in cancer care, little is known about the impact of barriers to care on timely outcomes. METHODS: We conducted a secondary analysis of the Boston Patient Navigation Research Program (PNRP) to examine the effect that the presence of barriers had on time to diagnostic resolution of abnormal breast or cervical cancer screening tests. We used multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome to examine the effect of the number of barriers, controlling for demographic covariates and clustered by patients' primary navigator. RESULTS: There were 1481 women who received navigation; mean age was 39 years; 32% were White, 27% Black, and 31% Hispanic; 28% had private health insurance; and 38% did not speak English. Overall, half (n=745, 50%) had documentation of one or more barriers to care. Women with barriers were more likely to be older, non-White, non-English language speakers, and on public or no health insurance compared with women without barriers. In multivariable analyses, we found less timely diagnostic resolution as the number of barriers increased (one barrier, adjusted hazard ratio [aHR] 0.81 [95% CI 0.56-1.17], p=0.26; two barriers, aHR 0.55 [95% CI 0.37-0.81], p=0.0025; three or more barriers, aHR 0.31 [95% CI 0.21-0.46], p<0.0001)]. CONCLUSION: Within a patient navigation program proven to reduce delays in care, we found that navigated patients with documented barriers to care experience less timely resolution of abnormal cancer screening tests.
Authors: Joann G Elmore; Connie Y Nakano; Hannah M Linden; Lisa M Reisch; John Z Ayanian; Eric B Larson Journal: Med Care Date: 2005-02 Impact factor: 2.983
Authors: Karen M Freund; Tracy A Battaglia; Elizabeth Calhoun; Donald J Dudley; Kevin Fiscella; Electra Paskett; Peter C Raich; Richard G Roetzheim Journal: Cancer Date: 2008-12-15 Impact factor: 6.860
Authors: Kristen J Wells; Tracy A Battaglia; Donald J Dudley; Roland Garcia; Amanda Greene; Elizabeth Calhoun; Jeanne S Mandelblatt; Electra D Paskett; Peter C Raich Journal: Cancer Date: 2008-10-15 Impact factor: 6.860
Authors: Sarabeth Broder-Fingert; Sarah Qin; Julia Goupil; Jessica Rosenberg; Marilyn Augustyn; Nate Blum; Amanda Bennett; Carol Weitzman; James P Guevara; Ada Fenick; Michael Silverstein; Emily Feinberg Journal: Autism Date: 2018-11-08
Authors: Elizabeth M Whitley; Peter C Raich; Donald J Dudley; Karen M Freund; Electra D Paskett; Steven R Patierno; Melissa Simon; Victoria Warren-Mears; Frederick R Snyder Journal: Cancer Date: 2016-09-20 Impact factor: 6.860
Authors: Jennifer S Haas; Steven J Atlas; Adam Wright; E John Orav; David G Aman; Erica S Breslau; Timothy E Burdick; Emily Carpenter; Frank Chang; Tin Dang; Courtney J Diamond; Sarah Feldman; Kimberly A Harris; Shoshana J Hort; Molly L Housman; Amrita Mecker; Constance D Lehman; Sanja Percac-Lima; Rebecca Smith; Amy J Wint; Jie Yang; Li Zhou; Anna N A Tosteson Journal: Contemp Clin Trials Date: 2021-08-08 Impact factor: 2.261
Authors: Ambili Ramachandran; Frederick R Snyder; Mira L Katz; Julie S Darnell; Donald J Dudley; Steven R Patierno; Mechelle R Sanders; Patricia A Valverde; Melissa A Simon; Victoria Warren-Mears; Tracy A Battaglia Journal: Cancer Date: 2015-08-19 Impact factor: 6.860
Authors: Ryan W Dobbs; James Stinson; Shaleen R Vasavada; Brandon M Caldwell; Vincent L Freeman; Daniel F Garvey; Jack Lu; Daniel M Moreira; Michael R Abern Journal: J Community Health Date: 2020-06