Lay navigator model for impacting cancer health disparities.

This paper recounts experiences, challenges, and lessons learned when implementing a lay patient navigator program to improve cancer care among medically underserved patients who presented in a primary care clinic with a breast or colorectal cancer abnormality. The program employed five lay navigators to navigate 588 patients. Central programmatic elements were the following: (1) use of bilingual lay navigators with familiarity of communities they served; (2) provision of training, education, and supportive activities; (3) multidisciplinary clinical oversight that factored in caseload intensity; and (4) well-developed partnerships with community clinics and social service entities. Deconstruction of healthcare system information was fundamental to navigation processes. We conclude that a lay model of navigation is well suited to assist patients through complex healthcare systems; however, a stepped care model that includes both lay and professional navigation may be optimal to help patients across the entire continuum.

A cluster randomized trial evaluating the efficacy of patient navigation in improving quality of diagnostic care for patients with breast or colorectal cancer abnormalities.

BACKGROUND: This study examines efficacy of a lay patient navigation (PN) program aimed to reduce time between a cancer abnormality and definitive diagnosis among racially/ethnically diverse and medically underserved populations of Tampa Bay, Florida. METHODS: Using a cluster randomized design, the study consisted of 11 clinics (six navigated; five control). Patients were navigated from time of a breast or colorectal abnormality to diagnostic resolution, and to completion of cancer treatment. Using a generalized mixed-effects model to assess intervention effects, we examined: (i) length of time between abnormality and definitive diagnosis, and (ii) receipt of definitive diagnosis within the 6-month minimum follow-up period. RESULTS: A total of 1,267 patients participated (588 navigated; 679 control). We also included data from an additional 309 chart abstractions (139 navigated arm; 170 control arm) that assessed outcomes at baseline. PN did not have a significant effect on time to diagnostic resolution in multivariable analysis that adjusted for race-ethnicity, language, insurance status, marital status, and cancer site (P = 0.16). Although more navigated patients achieved diagnostic resolution by 180 days, results were not statistically significant (74.5% navigated vs. 68.5% control, P = 0.07). CONCLUSIONS: PN did not impact the overall time to completion of diagnostic care or the number of patients who reached diagnostic resolution of a cancer abnormality. Further evaluation of PN programs applied to other patient populations across the cancer continuum is necessary to gain a better perspective on its effectiveness. IMPACT: PN programs may not impact timely resolution of an abnormality suspicious of breast or colorectal cancer.

Diagnostic resolution of cancer screening abnormalities at community health centers.

BACKGROUND: Few studies have examined timeliness of diagnostic evaluation of abnormal cancer screening tests in community health centers. METHODS: Using medical record review, timeliness of diagnosis was assessed among 317 people having either breast or colorectal-related abnormalities. RESULTS: For 241 subjects (76.0%) who reached clinical resolution, the median time to diagnostic resolution was 37 days. People with breast abnormalities had more than twice the odds (adjusted odds ratio: 2.84) of reaching diagnostic resolution within 180 days compared with patients with colorectal abnormalities. We found, however, no evidence of disparate outcomes according to patient race/ethnicity, insurance status, or spoken language. CONCLUSIONS: Diagnostic evaluations are often either not completed or are delayed after a cancer-related abnormality is discovered. Further research is needed to understand the patient, provider, and health care system factors that contribute to these delays. There was no evidence of cancer disparities in the community health centers studied.

Estimating maternal mortality in Monseñor Nouel Province, Dominican Republic.

OBJECTIVES: Maternal deaths are estimated by the World Health Organization at over 500,000 annually. Various methods of calculating mortality ratios have been utilized throughout the world, but many are inaccurate. The purpose of this study was to measure maternal mortality by using a sibling survivorship survey and by recording and tracking death certificates. METHODS: The data for the survey were collected within a specific province in the Dominican Republic that represents predominately rural communities. Interviews with 2,180 women and data from their 17,807 siblings were recorded, 9,723 of which were sisters. The Death Certificate data were obtained by tracking 3,430 records at the local government office in the same province. RESULTS: The results from the rural sibling survey show a maternal mortality ratio significantly higher than other national estimates (348/100,000 live births versus 72-250/100,000). Data collection methods are discussed, including government record keeping and potential sources of inaccuracy. CONCLUSION: Reported maternal mortality ratios may not portray the true magnitude of the poor health status of women in developing countries.