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APHA Scientific Session and Event Listing |
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APHA Scientific Session and Event Listing |
Karen Freund, MD, MPH, Director, BU Center of Excellence in Women's Health, Chief, Women's Health Unit, Boston Medical Center, 720 Harrison Avenue, Suite 1108, Boston, MA 02118, 617-638-8036, karen.freund@bmc.org, Tracy Battaglia, MD, MPH, Associate Professor, Boston University School of Medicine, 720 Harrision Avenue, Boston, MA 02118, Gay Plungas, MPH, Boston Medical Center, Program Director, Women's Health Research Unit, 720 Harrision Avenue, Boston, MA 02118, Jack Clark, PhD, Health Services, Boston University School of Public Health, 715 Albany Street, T3-W, Boston, MA 02118, Tim Lash, ScD, Associate Professor, BU School of Public Health, 715 Albany Street, Boston, MA 02118, Julie Darnell, MHSA, AM, School of Public Health, Division of Health Policy and Administration, University of Illinois, Chicago, 1603 W. Taylor Street, Room 719, Chicago, IL 60612-4310, Diane Fairclough, DrPH, Colorado Health Outcomes Program, University of Colorado Health Sciences Center, 6508, Mail stop F443, Aurora, CO 80045, David M. Murray, PhD, Chair, Division of Epidemiology, Ohio State University, 320 W. 10th Ave., B222 Starling-Loving Hall, Columbus, OH 43210, Katrina L. Ramsey, Northwest Tribal Cancer Navigator Program, Northwest Portland Area Indian Health Board, 527 SW Hall, Suite 300, Portland, OR 97201, Kevin Fiscella, MD, MPH, University of Rochester Medical Center, Associate Professor of Family Medicine and Community & Preventive Medicine, Dept. of Family Medicine, 1381 South Avenue, Rochester, NY 14620, Jennifer Griggs, MD, University of Rochester Medical Center, Co-Director Comprehensive Breast Cancer Program, James P. Wilmot Cancer Center, 1381 South Avenue, Rochester, NY 14620, Donald Dudley, MD, University of Texas Health Sciences Center at San Antonio, Professor, Dept. of Obstetrics and Gynecology, 7703 Floyd Curl Drive, San Antonio, TX 78229, Alicia Bahadur, MPH, H. Lee Moffitt Cancer Center and Research Institute, Program Manager, Patient Navigation Program, 4117 E. Fowler Avenue, Tampa, FL 33617, and Carla Williams, PhD, Howard University Cancer Center, 2041 Georgia Ave, NW, Washington, DC 20060.
Measuring Patient Navigation
Problem:
Ethnic and racial disparities in cancer outcomes are in part due to inequities in the timely completion of diagnosis and treatment. Delays result from multiple barriers in a system that involves multiple specialties, modalities, and sites of care. Patient navigation has been proposed as a new role to support patients and ensure efficient access to needed care. To date, few controlled studies have evaluated patient navigation, and there is little consensus on how best to measure the processes and outcomes of this innovation.
Methods:
The National Cancer Institute, with additional support of the American Cancer Society has funded nine sites as part of the Patient Navigation Research Program (PNRP), a Cooperative Agreement to evaluate the benefits and costs of patient navigation. The PNRP addresses navigation of the process of care for breast, cervical, colorectal and prostate cancer, and supports patients from the time of a screening abnormality through diagnostic evaluation and treatment if cancer is diagnosed.
The nine sites, utilizing a committee structure, reviewed the proposals of each site, the medical literature, discussions with content experts, and websites of related unpublished research programs. Through the consensus process, commonalities across all sites were described and a common set of data elements emerged.
Results:
The committee identified the following common metrics to measure the process and outcomes of patient navigation:
a) Clinical time endpoints - including time to completing diagnostic evaluation, and time to complete primary therapy; b) Appropriateness of therapy - including commonly accepted standards of therapy goals for each cancer, given the stage of diagnosis or other diagnostic components; c) Process of navigation - including methods to evaluate the number of contacts navigators have with each client, to identify the types of support offered, and to evaluate the network of contacts from which the navigator draws to support clients; d) Cost-effectiveness - including a limited cost effectiveness plan, to evaluate the incremental costs of navigation against improvements in appropriate, complete, and timely care; and e) Patient satisfaction - including selected validated measures that address satisfaction with the components of care for which navigation is planned.
Conclusions: The metrics chosen and developed by this group can serve as evaluation metrics for other programs addressing patient navigation, which would facilitate the comparison of patient navigation outcomes in a variety of settings beyond those encompassed by PNRP.
Learning Objectives:
Keywords: Access to Care, Research
Presenting author's disclosure statement:
Any relevant financial relationships? No
The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA