title: The effect of nurse navigation on timeliness of breast cancer care at an academic comprehensive cancer center.
abstract: BACKGROUND
  A patient navigation process is required for accreditation by the National Accreditation Program for Breast Centers (NAPBC). Patient navigation has previously been shown to improve timely diagnosis in patients with breast cancer. This study sought to assess the effect of nurse navigation on timeliness of care following the diagnosis of breast cancer by comparing patients who were treated in a comprehensive cancer center with and without the assistance of nurse navigation.
  
  
  METHODS
  Navigation services were initiated at an NAPBC-accredited comprehensive breast center in July 2010. Two 9-month study intervals were chosen for comparison of timeliness of care: October 2009 through June 2010 and October 2010 through June 2011. All patients with breast cancer diagnosed in the cancer center with stage 0 to III disease during the 2 study periods were identified by retrospective cancer registry review. Time from diagnosis to initial oncology consultation was measured in business days, excluding holidays and weekends.
  
  
  RESULTS
  Overall, 176 patients met inclusion criteria: 100 patients prior to and 76 patients following nurse navigation implementation. Nurse navigation was found to significantly shorten time to consultation for patients older than 60 years (B = -4.90, P = .0002). There was no change in timeliness for patients 31 to 60 years of age.
  
  
  CONCLUSIONS
  Short-term analysis following navigation implementation showed decreased time to consultation for older patients, but not younger patients. Further studies are indicated to assess the long-term effects and durability of this quality improvement initiative.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Mohua
authors.initials: M
authors.lastname: Basu
authors.forename: Jared
authors.initials: J
authors.lastname: Linebarger
authors.forename: Sheryl G A
authors.initials: SG
authors.lastname: Gabram
authors.forename: Sharla Gayle
authors.initials: SG
authors.lastname: Patterson
authors.forename: Miral
authors.initials: M
authors.lastname: Amin
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005845:Georgia; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D016014:Linear Models; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D024802:Nurse's Role; D062526:Patient Navigation / Q000592:standards*; D012017:Referral and Consultation; D012042:Registries; D012189:Retrospective Studies; D012621:Seasons; D012923:Social Class; D061665:Time-to-Treatment / Q000458:organization & administration / Q000592:standards*
keywords: breast cancer; delivery of care; disease management; patient navigation; quality of care