Patient navigation and the quality of breast cancer care: an analysis of the breast cancer care quality indicators.
OBJECTIVE
Patient navigation programs are initiated to help guide patients through barriers in a complex cancer care system. We sought to analyze the impact of our patient navigator program on the adherence to specific Breast Cancer Care Quality Indicators (BCCQI).


METHODS
A retrospective cohort of patients with stage I-III breast cancer seen the calendar year prior to the initiation of the patient navigation program were compared with patients treated in the ensuing two calendar years. Quality indicators deemed appropriate for analysis were those associated with overcoming barriers to treatment and those associated with providing health education and improving patient decision-making.


RESULTS
A total of 134 consecutive patients between January 1, 2006 and December 31, 2006 and 234 consecutive patients between January 1, 2008 and December 31, 2009 were evaluated for compliance with the BCCQI. There was no significant difference in the mean age or race/ethnic distribution of the study population. In all ten BCCQI evaluated, there was improvement in the percentage of patients in compliance from pre and post implementation of a patient navigator program (range 2.5-27.0 %). Overall, compliance with BCCQI improved from 74.1 to 95.5 % (p < 0.0001). Indicators associated with informed decision-making and patient preference achieved statistical significance, while only completion axillary node dissection in sentinel node-positive biopsies in the process of treatment achieved statistical significance.


CONCLUSIONS
The implementation of a patient navigator program improved breast cancer care as measured by BCCQI. The impact on disease-free and overall survival remains to be determined.
Department of Surgery, Division of Surgical Oncology, Breast Program Leader, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
Joseph J
JJ
Weber
Debra C
DC
Mascarenhas
Lisa S
LS
Bellin
Rachel E
RE
Raab
Jan H
JH
Wong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010344:Patient Advocacy; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011379:Prognosis; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies