Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, 2100-W Pennsylvania Avenue, NW, 8th Floor, Washington, DC 20037, USA.
Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1655-63. doi: 10.1158/1055-9965.EPI-12-0479.
Patient Navigation (PN) originated in Harlem as an intervention to help poor women overcome access barriers to timely breast cancer treatment. Despite rapid, nationally widespread adoption of PN, empirical evidence on its effectiveness is lacking. In 2005, National Cancer Institute initiated a multicenter PN Research Program (PNRP) to measure PN effectiveness for several cancers. The George Washington Cancer Institute, a project participant, established District of Columbia (DC)-PNRP to determine PN's ability to reduce breast cancer diagnostic time (number of days from abnormal screening to definitive diagnosis).
A total of 2,601 women (1,047 navigated; 1,554 concurrent records-based nonnavigated) were examined for breast cancer from 2006 to 2010 at 9 hospitals/clinics in DC. Analyses included only women who reached complete diagnostic resolution. Differences in diagnostic time between navigation groups were tested with ANOVA models including categorical demographic and treatment variables. Log transformations normalized diagnostic time. Geometric means were estimated and compared using Tukey-Kramer P value adjustments.
Average-geometric mean [95% confidence interval (CI)]-diagnostic time (days) was significantly shorter for navigated, 25.1 (21.7, 29.0), than nonnavigated women, 42.1 (35.8, 49.6). Subanalyses revealed significantly shorter average diagnostic time for biopsied navigated women, 26.6 (21.8, 32.5) than biopsied nonnavigated women, 57.5 (46.3, 71.5). Among nonbiopsied women, diagnostic time was shorter for navigated, 27.2 (22.8, 32.4), than nonnavigated women, 34.9 (29.2, 41.7), but not statistically significant.
Navigated women, especially those requiring biopsy, reached their diagnostic resolution significantly faster than nonnavigated women.
Results support previous findings of PN's positive influence on health care. PN should be a reimbursable expense to assure continuation of PN programs.
患者导航员（PN）起源于哈莱姆区，是一种帮助贫困妇女克服及时获得乳腺癌治疗的障碍的干预措施。尽管全国范围内迅速采用了 PN，但缺乏其有效性的实证证据。2005 年，美国国家癌症研究所启动了一项多中心 PN 研究计划（PNRP），以衡量 PN 对多种癌症的有效性。作为项目参与者之一的乔治华盛顿癌症研究所（GWCI）建立了哥伦比亚特区（DC）-PNRP，以确定 PN 缩短乳腺癌诊断时间（从异常筛查到明确诊断的天数）的能力。
2006 年至 2010 年，在 DC 的 9 家医院/诊所，共有 2601 名妇女（1047 名接受导航员服务；1554 名接受记录基非导航员服务）接受乳腺癌检查。分析仅包括达到完全诊断性缓解的妇女。使用包括分类人口统计学和治疗变量的方差分析模型测试导航组之间的诊断时间差异。对数转换使诊断时间正态化。使用 Tukey-Kramer P 值调整估计和比较几何平均值。
接受导航员服务的妇女的平均几何均数[95%置信区间（CI）]-诊断时间（天）明显短于未接受导航员服务的妇女，分别为 25.1（21.7，29.0）和 42.1（35.8，49.6）。亚分析显示，接受活检的接受导航员服务的妇女的平均诊断时间明显短于接受活检的未接受导航员服务的妇女，分别为 26.6（21.8，32.5）和 57.5（46.3，71.5）。在未接受活检的妇女中，接受导航员服务的妇女的诊断时间明显短于未接受导航员服务的妇女，分别为 27.2（22.8，32.4）和 34.9（29.2，41.7），但无统计学意义。
接受导航员服务的妇女，特别是需要活检的妇女，达到诊断性缓解的速度明显快于未接受导航员服务的妇女。
结果支持 PN 对医疗保健产生积极影响的先前发现。PN 应作为可报销费用，以确保 PN 计划的持续开展。
