title: Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population.
abstract: BACKGROUND
  Barriers to timely resolution of abnormal cancer screening tests add to cancer health disparities among low-income, uninsured, and minority populations. We conducted a randomized trial to evaluate the impact of lay patient navigators on time to resolution and completion of follow-up testing among patients with abnormal screening tests in a medically underserved patient population.
  
  
  METHODS
  Denver Health, the safety-net health care system serving Denver, is one of 10 performance sites participating in the Patient Navigation Research Program. Of 993 eligible subjects with abnormal screening tests randomized to navigation and no-navigation (control) arms and analyzed, 628 had abnormal breast screens (66 abnormal clinical breast examinations, 304 BIRADS 0, 200 BIRADS 3, 58 BIRADS 4 or 5) whereas 235 had abnormal colorectal and 130 had abnormal prostate screens.
  
  
  RESULTS
  Time to resolution was significantly shorter in the navigated group (stratified log rank test, P < 0.001). Patient navigation improved diagnostic resolution for patients presenting with mammographic BIRADS 3 (P = 0.0003) and BIRADS 0 (P = 0.09), but not BIRADS 4/5 or abnormal breast examinations. Navigation shortened the time for both colorectal (P = 0.0017) and prostate screening resolution (P = 0.06). Participant demographics included 72% minority, 49% with annual household income less than $10,000, and 36% uninsured.
  
  
  CONCLUSIONS
  Patient navigation positively impacts time to resolution of abnormal screening tests for breast, colorectal, and prostate cancers in a medically underserved population.
  
  
  CONCLUSIONS
  By shortening the time to and increasing the proportion of patients with diagnostic resolution patient navigation could reduce disparities in stage at diagnosis and improve cancer outcomes.
authors.affiliation: Corresponding Author: Peter C. Raich, Denver Health, 777 Bannock Street, MC 4001, Denver, CO 80204.  praich@thesmartphr.com.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Raich
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Whitley
authors.forename: William
authors.initials: W
authors.lastname: Thorland
authors.forename: Patricia
authors.initials: P
authors.lastname: Valverde
authors.forename: Diane
authors.initials: D
authors.lastname: Fairclough
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000175:diagnosis; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062526:Patient Navigation; D011471:Prostatic Neoplasms / Q000175:diagnosis; D013997:Time Factors