title: Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia.
abstract: BACKGROUND
  Patient Navigation (PN) originated in Harlem as an intervention to help poor women overcome access barriers to timely breast cancer treatment. Despite rapid, nationally widespread adoption of PN, empirical evidence on its effectiveness is lacking. In 2005, National Cancer Institute initiated a multicenter PN Research Program (PNRP) to measure PN effectiveness for several cancers. The George Washington Cancer Institute, a project participant, established District of Columbia (DC)-PNRP to determine PN's ability to reduce breast cancer diagnostic time (number of days from abnormal screening to definitive diagnosis).
  
  
  METHODS
  A total of 2,601 women (1,047 navigated; 1,554 concurrent records-based nonnavigated) were examined for breast cancer from 2006 to 2010 at 9 hospitals/clinics in DC. Analyses included only women who reached complete diagnostic resolution. Differences in diagnostic time between navigation groups were tested with ANOVA models including categorical demographic and treatment variables. Log transformations normalized diagnostic time. Geometric means were estimated and compared using Tukey-Kramer P value adjustments.
  
  
  RESULTS
  Average-geometric mean [95% confidence interval (CI)]-diagnostic time (days) was significantly shorter for navigated, 25.1 (21.7, 29.0), than nonnavigated women, 42.1 (35.8, 49.6). Subanalyses revealed significantly shorter average diagnostic time for biopsied navigated women, 26.6 (21.8, 32.5) than biopsied nonnavigated women, 57.5 (46.3, 71.5). Among nonbiopsied women, diagnostic time was shorter for navigated, 27.2 (22.8, 32.4), than nonnavigated women, 34.9 (29.2, 41.7), but not statistically significant.
  
  
  CONCLUSIONS
  Navigated women, especially those requiring biopsy, reached their diagnostic resolution significantly faster than nonnavigated women.
  
  
  CONCLUSIONS
  Results support previous findings of PN's positive influence on health care. PN should be a reimbursable expense to assure continuation of PN programs.
authors.affiliation: Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, 2100-W Pennsylvania Avenue, NW, 8th Floor, Washington, DC 20037, USA. hhoffman@gwu.edu
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Hoffman
authors.forename: Nancy L
authors.initials: NL
authors.lastname: LaVerda
authors.forename: Heather A
authors.initials: HA
authors.lastname: Young
authors.forename: Paul H
authors.initials: PH
authors.lastname: Levine
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Alexander
authors.forename: Rachel
authors.initials: R
authors.lastname: Brem
authors.forename: Larisa
authors.initials: L
authors.lastname: Caicedo
authors.forename: Jennifer
authors.initials: J
authors.lastname: Eng-Wong
authors.forename: Wayne
authors.initials: W
authors.lastname: Frederick
authors.forename: William
authors.initials: W
authors.lastname: Funderburk
authors.forename: Elmer
authors.initials: E
authors.lastname: Huerta
authors.forename: Sandra
authors.initials: S
authors.lastname: Swain
authors.forename: Steven R
authors.initials: SR
authors.lastname: Patierno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis*; D057210:Delayed Diagnosis / Q000517:prevention & control*; D004219:District of Columbia; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D062526:Patient Navigation; D011446:Prospective Studies; D013997:Time Factors