Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening.

Published

Journal Article

OBJECTIVE: As part of the Patient Navigation Research Program, we examined the effect of patient navigation versus usual care on timely diagnostic follow-up, defined as clinical management for women with cervical abnormalities within accepted time frames. METHODS: Participants from four Patient Navigation Research Program centers were divided into low- and high-risk abnormality groups and analyzed separately. Low-risk participants (n = 2088) were those who enrolled with an initial Pap test finding of atypical squamous cells of undetermined significance (ASCUS) with a positive high-risk human papillomavirus (HPV) serotype, atypical glandular cells, or low-grade squamous intraepithelial lesion (LGSIL). High-risk participants were those with an initial finding of high-grade squamous intraepithelial lesion (HGSIL) (n = 229). A dichotomous outcome of timely diagnostic follow-up within 180 days was used for the low-risk abnormality group and timely diagnostic follow-up within 60 days for the high-risk group, consistent with treatment guidelines. A logistic mixed-effects regression model was used to evaluate the intervention effect using a random effect for study arm within an institution. A backward selection process was used for multivariable model building, considering the impact of each predictor on the intervention effect. RESULTS: Low-risk women in the patient navigation arm showed an improvement in the odds of timely diagnostic follow-up across all racial groups, but statistically significant effects were only observed in non-English-speaking Hispanics (OR 5.88, 95% CI 2.81-12.29). No effect was observed among high-risk women. CONCLUSION: These results suggest that patient navigation can improve timely diagnostic follow-up among women with low-risk cervical abnormalities, particularly in non-English-speaking Hispanic women.

Full Text

Duke Authors

Cited Authors

  • Paskett, ED; Dudley, D; Young, GS; Bernardo, BM; Wells, KJ; Calhoun, EA; Fiscella, K; Patierno, SR; Warren-Mears, V; Battaglia, TA; PNRP Investigators,

Published Date

  • January 2016

Published In

Volume / Issue

  • 25 / 1

Start / End Page

  • 15 - 21

PubMed ID

  • 26625131

Pubmed Central ID

  • 26625131

Electronic International Standard Serial Number (EISSN)

  • 1931-843X

Digital Object Identifier (DOI)

  • 10.1089/jwh.2014.5094

Language

  • eng

Conference Location

  • United States