患者对异常乳腺 X 光检查后续临床护理和患者导航的看法。
Patient perspectives of clinical care and patient navigation in follow-up of abnormal mammography.
机构信息
Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA.
出版信息
J Gen Intern Med. 2011 Feb;26(2):116-22. doi: 10.1007/s11606-010-1436-4. Epub 2010 Jul 7.
BACKGROUND
Racial and ethnic disparities in cancer care and survival are well documented. Patient navigation has been shown to improve timely follow-up of abnormal breast screenings for underserved patients. Few studies showed the impact of navigation on patient experiences of care.
OBJECTIVE
We compared the experiences of patients enrolled in a patient navigator program and non-navigated patients referred to a hospital breast center for follow-up of abnormal mammogram in an underserved community health center population.
DESIGN
Group comparison study using data from a mail and telephone survey to measure the experience of navigated and non-navigated patients.
PARTICIPANTS
English- and Spanish-speaking patients with abnormal mammography attending the Avon Breast Center between April 1, 2005 and April 30, 2007. Seventy-two navigated patients and 181 non-navigated patients completed surveys; the survey response rate was 53.6%.
MAIN MEASURES
Timeliness of care, preparation for the visit to the breast center, ease of access, quality of care, provider communication, unmet need and patient satisfaction.
KEY RESULTS
Most measures of the patient experience did not differ between navigated and non-navigated patients. Overall quality of care was rated as excellent (55% vs 62%, p = 0.294). Navigated patients were significantly more likely than non-navigated to 'definitely' understand what to expect at their visit (79% vs 60%, p = 0.003), to receive a reminder letter or telephone call (89% vs 77%, p = 0.029), and to feel welcome (89% vs 75%, p = 0.012). Navigated patients were less likely than non-navigated to rate the concern shown for their cultural/religious beliefs as excellent (45% vs 54%, p = 0.014).
CONCLUSIONS
Assessing patient perspectives is essential to evaluate the success of quality improvement interventions. In our center, we measured few significant disparities in the perceptions of care of these two very different populations of patients, although, there are still areas in which our program needs improvement. Further research is needed to understand the effectiveness of patient navigation programs in reducing racial and ethnic disparities.
背景
癌症治疗和生存方面的种族和民族差异得到了充分记录。患者导航已被证明可以改善服务不足患者的异常乳房筛查的及时随访。很少有研究表明导航对患者护理体验的影响。
目的
我们比较了参与患者导航计划的患者和被转诊到医院乳房中心接受服务不足社区保健中心人群异常乳房 X 光检查随访的非导航患者的体验。
设计
使用邮件和电话调查数据进行组间比较研究，以衡量导航和非导航患者的体验。
参与者
2005 年 4 月 1 日至 2007 年 4 月 30 日期间在埃文乳房中心就诊的英语和西班牙语异常乳房 X 光检查患者。72 名导航患者和 181 名非导航患者完成了调查；调查的回复率为 53.6%。
主要措施
护理及时性、就诊准备、就诊方便性、护理质量、提供者沟通、未满足的需求和患者满意度。
主要结果
大多数患者体验指标在导航和非导航患者之间没有差异。整体护理质量被评为优秀（55%对 62%，p=0.294）。与非导航患者相比，导航患者更有可能“肯定”了解就诊时的预期（79%对 60%，p=0.003），收到提醒信或电话（89%对 77%，p=0.029），并感到受欢迎（89%对 75%，p=0.012）。与非导航患者相比，导航患者对其文化/宗教信仰表示关注的比例较低（45%对 54%，p=0.014）。
结论
评估患者观点对于评估质量改进干预措施的成功至关重要。在我们的中心，我们衡量了这两个非常不同的患者群体对护理的看法，只有少数存在显著差异，但我们的计划仍有需要改进的地方。需要进一步研究以了解患者导航计划在减少种族和民族差异方面的有效性。
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