Despite advances in early detection and treatment options, racial/ethnic minority and low socioeconomic status women continue to suffer advanced stage at diagnosis and higher mortality for both breast and cervical cancer. Delays in diagnosis and treatment, which contribute to poorer outcomes, have been associated with well known barriers to care. These disparities persist despite this knowledge represents a gap between discovery and delivery of cancer care resulting in a pressing need for effective interventions. The objective of this study is to design, implement and evaluate a patient navigator intervention at six community health centers in Boston, Massachusetts. These sites represents a wide range of racial/ethnic minority and low socioeconomic status women served by an urban safety net institution that mirrors the infrastructure of this country's urban health systems. The intervention is a model based on Andersen's Model of Health Services Use. Aided by an Electronic Medical Record tracking system and theory based cultural competency training, patient navigators will: identify cases, provide service coordination and direct patient support.
Our specific aims are to determine if the intervention will: 1. Reduce time to diagnosis (or resolution of abnormality) after an abnormal mammogram or Pap smear; 2. Reduce time to complete treatment and provide higher quality treatment after a cancer diagnosis; 3. Improve patient satisfaction with health care services; 4. Have critical components (time with patient vs. time coordinating care) which drive its success; 5. Result in more cost-effective care. We will use a quasi-experimental design with block randomization of six community health centers whose primary affiliation is with Boston Medical Center. Each site will be randomly assigned to either Breast or Cervical Patient Navigation. Thus, each of the Breast intervention sites will serve as a continuous comparison site for the Cervical intervention sites and vice versa. We expect that the results of this study will inform the design of a generalizable standard, effective and cost efficient patient navigation model that will eliminate barriers to timely, quality cancer care among racial/ethnic minority and lower income populations
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