268624 Patient navigation leads to increased rates of timely definitive diagnosis in Latinas with BIRADS-3 breast abnormalities –The Six Cities Study

Monday, October 29, 2012 : 9:06 AM - 9:24 AM

Amelie Ramirez, DrPH , Dept of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX
Eliseo J. Perez-Stable, MD , Department Medicine, University of California, San Francisco, San Francisco, CA
Gregory Talavera, MD, MPH , Graduate School of Public Health, San Diego State University, San Diego, CA
Frank Penedo, PhD , Department of Medical Social Sciences / Northwestern University, Northwestern University, Chicago, IL
Emilio Carillo, MD , Weill Cornell Medical College, Cornell University, New York, NY
María E. Fernández, PhD , Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX
Alan Holden, PhD , The Institute for Health Promotion Research, Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX
Edgar Munoz, MS , The Institute of Health Promotion Research, Dept of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, TX
Sandra San Miguel, MS , Dept. Epidemiology & Biostatistics, School of Medicine, Institute of Health Promotion Research, The University of Texas Health Science Center at San Antonio, San Antonio, TX
Kipling Gallion, MA , Dept of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX
Abstract: BACKGROUND: Our controlled patient navigation trial in Latinas from six U.S. cities showed that navigated Latinas with BIRADS-3 abnormal screens achieve definitive diagnosis significantly faster than their non-navigated counterparts. Here we explore whether increased efficacy in diagnosis through navigation is clinically meaningful and why. METHODS: Based on CDC standards we identified a period of 60 days within the date of initial breast cancer screening as “timely definitive diagnosis” in 133 women from the larger Six Cities Study with abnormal breast screens radiologically classified as BIRADS-3. We compared navigated versus non-navigated Latinas using chi-squared and multiple logistic regression analysis, and hierarchical multiple logistic regression to determine clinic and patient-level measures explaining timely diagnosis. RESULTS: 133 Latinas were classified as BIRADS-3. There were no significant group differences in demographic measures. Significantly more navigated than non-navigated Latinas achieved timely diagnosis (94.5% versus 71.7%, p=.001 when the 6-month waiting period was controlled). This statistical difference remained (p=.022) after controlling for clinical characteristics (% Hispanic patients, uninsured patients, Birads-3 screens, and a high-tech index; all p<.05). Fewer BIRADS-3 Latinas missed scheduled appointments (11.6% v. 23.8%, p=.047) or were lost to follow-up (3.3% versus 10.7%, p=.042). Fewer missed appointments explains some, but not all of the navigation affect. CONCLUSIONS: Patient-centered navigation increases timely diagnosis in Latinas with a BIRADS-3 result. This increase exceeds the CDC standard for acceptable rates of timely diagnosis (75%) in abnormal breast screening by approximately 26%. The increased rate has significant benefits including fewer missed appointments and lower group attrition rates.

Learning Areas:
Advocacy for health and health education
Clinical medicine applied in public health
Program planning
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Describe the BIRADS radiological classification system for abnormal breast screening. 2. Define "timely definitive diagnosis". 3. Demonstrate the efficacy of patient navigation among Latinas with BIRADS-3 abnormal screening in achieving timely definitive diagnosis.

Keywords: Latinas, Breast Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: With a background in health disparities research in cancer and chronic disease prevention, I have designed, led and evaluated large-scale studies for more than 20 years. I have designed and implemented 100-plus national, state, and local programs that encourage interdisciplinary collaboration and innovative research among institutions, researchers, groups, and the public. All programs are theory-based and focus on cancer/disease prevention. Important emphases of this work are Latinas, breast cancer, and patient navigation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.