Robert H, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
BMC Health Serv Res. 2012 Sep 25;12:340. doi: 10.1186/1472-6963-12-340.
Patient navigation programs have been launched nationwide in an attempt to reduce racial/ethnic and socio-demographic disparities in cancer care, but few have evaluated outcomes in the prostate cancer setting. The National Cancer Institute-funded Chicago Patient Navigation Research Program (C-PNRP) aims to implement and evaluate the efficacy of a patient navigation intervention for predominantly low-income minority patients with an abnormal prostate cancer screening test at a Veterans Affairs (VA) hospital in Chicago.
METHODS/DESIGN: From 2006 through 2010, C-PNRP implemented a quasi-experimental intervention whereby trained social worker and lay health navigators worked with veterans with an abnormal prostate screen to proactively identify and resolve personal and systems barriers to care. Men were enrolled at a VA urology clinic and were selected to receive navigated versus usual care based on clinic day. Patient navigators performed activities to facilitate timely follow-up such as appointment reminders, transportation coordination, cancer education, scheduling assistance, and social support as needed. Primary outcome measures included time (days) from abnormal screening to diagnosis and time from diagnosis to treatment initiation. Secondary outcomes included psychosocial and demographic predictors of non-compliance and patient satisfaction. Dates of screening, follow-up visits, and treatment were obtained through chart audit, and questionnaires were administered at baseline, after diagnosis, and after treatment initiation. At the VA, 546 patients were enrolled in the study (245 in the navigated arm, 245 in the records-based control arm, and 56 in a subsample of surveyed control subjects).
Given increasing concerns about balancing better health outcomes with lower costs, careful examination of interventions aimed at reducing healthcare disparities attain critical importance. While analysis of the C-PNRP data is underway, the design of this patient navigation intervention will inform other patient navigation programs addressing strategies to improve prostate cancer outcomes among vulnerable populations.
为了减少癌症治疗中种族/民族和社会人口统计学差异，全国范围内已经启动了患者导航计划，但很少有研究评估前列腺癌治疗中的结果。国家癌症研究所资助的芝加哥患者导航研究计划（C-PNRP）旨在实施和评估针对芝加哥退伍军人事务部（VA）医院中主要为低收入少数民族患者的异常前列腺癌筛查试验的患者导航干预措施的疗效。
方法/设计：从 2006 年到 2010 年，C-PNRP 实施了一项准实验性干预措施，训练有素的社会工作者和非专业健康导航员与异常前列腺筛查的退伍军人合作，积极识别和解决个人和系统护理障碍。男性在 VA 泌尿科诊所登记，并根据就诊日选择接受导航护理或常规护理。患者导航员通过预约提醒、交通协调、癌症教育、日程安排协助和必要的社会支持等活动促进及时随访。主要结局指标包括从异常筛查到诊断的时间（天）和从诊断到治疗开始的时间。次要结局指标包括不合规和患者满意度的社会心理和人口统计学预测因素。通过图表审查获取筛查、随访和治疗日期，并在基线、诊断后和治疗开始后进行问卷调查。在 VA，有 546 名患者参与了这项研究（导航组 245 名，基于记录的对照组 245 名，以及调查对照组的 56 名亚组）。
鉴于人们越来越关注在改善健康结果和降低成本之间取得平衡，仔细检查旨在减少医疗保健差异的干预措施变得至关重要。虽然正在对 C-PNRP 数据进行分析，但该患者导航干预措施的设计将为其他针对改善弱势群体前列腺癌结果的患者导航计划提供信息。
