Electra D Paskett1,2, Donald Dudley3, Gregory S Young4, Brittany M Bernardo2, Kristen J Wells5, Elizabeth A Calhoun6, Kevin Fiscella7, Steven R Patierno8,9, Victoria Warren-Mears10, Tracy A Battaglia11. 1. 1 Division of Cancer Prevention and Control, Ohio State University , Columbus, Ohio. 2. 2 Comprehensive Cancer Center, Ohio State University , Columbus, Ohio. 3. 3 Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio , San Antonio, Texas. 4. 4 Center for Biostatistics, Ohio State University , Columbus, Ohio. 5. 5 Department of Psychology, San Diego State University , San Diego, California. 6. 6 Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago , Chicago, Illinois. 7. 7 Division of Oncology, Department of Family Medicine, Community, and Preventive Medicine, James P. Wilmont Cancer Center, University of Rochester , Rochester, New York. 8. 8 George Washington University Cancer Institute , Washington, DC. 9. 9 Duke Cancer Institute , Durham, North Carolina. 10. 10 Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center , Portland, Oregon. 11. 11 Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine , Boston, Massachusetts.
Abstract
OBJECTIVE: As part of the Patient Navigation Research Program, we examined the effect of patient navigation versus usual care on timely diagnostic follow-up, defined as clinical management for women with cervical abnormalities within accepted time frames. METHODS: Participants from four Patient Navigation Research Program centers were divided into low- and high-risk abnormality groups and analyzed separately. Low-risk participants (n = 2088) were those who enrolled with an initial Pap test finding of atypical squamous cells of undetermined significance (ASCUS) with a positive high-risk human papillomavirus (HPV) serotype, atypical glandular cells, or low-grade squamous intraepithelial lesion (LGSIL). High-risk participants were those with an initial finding of high-grade squamous intraepithelial lesion (HGSIL) (n = 229). A dichotomous outcome of timely diagnostic follow-up within 180 days was used for the low-risk abnormality group and timely diagnostic follow-up within 60 days for the high-risk group, consistent with treatment guidelines. A logistic mixed-effects regression model was used to evaluate the intervention effect using a random effect for study arm within an institution. A backward selection process was used for multivariable model building, considering the impact of each predictor on the intervention effect. RESULTS: Low-risk women in the patient navigation arm showed an improvement in the odds of timely diagnostic follow-up across all racial groups, but statistically significant effects were only observed in non-English-speaking Hispanics (OR 5.88, 95% CI 2.81-12.29). No effect was observed among high-risk women. CONCLUSION: These results suggest that patient navigation can improve timely diagnostic follow-up among women with low-risk cervical abnormalities, particularly in non-English-speaking Hispanic women.
OBJECTIVE: As part of the Patient Navigation Research Program, we examined the effect of patient navigation versus usual care on timely diagnostic follow-up, defined as clinical management for women with cervical abnormalities within accepted time frames. METHODS:Participants from four Patient Navigation Research Program centers were divided into low- and high-risk abnormality groups and analyzed separately. Low-risk participants (n = 2088) were those who enrolled with an initial Pap test finding of atypical squamous cells of undetermined significance (ASCUS) with a positive high-risk human papillomavirus (HPV) serotype, atypical glandular cells, or low-grade squamous intraepithelial lesion (LGSIL). High-risk participants were those with an initial finding of high-grade squamous intraepithelial lesion (HGSIL) (n = 229). A dichotomous outcome of timely diagnostic follow-up within 180 days was used for the low-risk abnormality group and timely diagnostic follow-up within 60 days for the high-risk group, consistent with treatment guidelines. A logistic mixed-effects regression model was used to evaluate the intervention effect using a random effect for study arm within an institution. A backward selection process was used for multivariable model building, considering the impact of each predictor on the intervention effect. RESULTS: Low-risk women in the patient navigation arm showed an improvement in the odds of timely diagnostic follow-up across all racial groups, but statistically significant effects were only observed in non-English-speaking Hispanics (OR 5.88, 95% CI 2.81-12.29). No effect was observed among high-risk women. CONCLUSION: These results suggest that patient navigation can improve timely diagnostic follow-up among women with low-risk cervical abnormalities, particularly in non-English-speaking Hispanic women.
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