title: Multiple barriers delay care among women with abnormal cancer screening despite patient navigation.
abstract: BACKGROUND
  While there is widespread dissemination of patient navigation programs in an effort to reduce delays in cancer care, little is known about the impact of barriers to care on timely outcomes.
  
  
  METHODS
  We conducted a secondary analysis of the Boston Patient Navigation Research Program (PNRP) to examine the effect that the presence of barriers had on time to diagnostic resolution of abnormal breast or cervical cancer screening tests. We used multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome to examine the effect of the number of barriers, controlling for demographic covariates and clustered by patients' primary navigator.
  
  
  RESULTS
  There were 1481 women who received navigation; mean age was 39 years; 32% were White, 27% Black, and 31% Hispanic; 28% had private health insurance; and 38% did not speak English. Overall, half (n=745, 50%) had documentation of one or more barriers to care. Women with barriers were more likely to be older, non-White, non-English language speakers, and on public or no health insurance compared with women without barriers. In multivariable analyses, we found less timely diagnostic resolution as the number of barriers increased (one barrier, adjusted hazard ratio [aHR] 0.81 [95% CI 0.56-1.17], p=0.26; two barriers, aHR 0.55 [95% CI 0.37-0.81], p=0.0025; three or more barriers, aHR 0.31 [95% CI 0.21-0.46], p<0.0001)].
  
  
  CONCLUSIONS
  Within a patient navigation program proven to reduce delays in care, we found that navigated patients with documented barriers to care experience less timely resolution of abnormal cancer screening tests.
authors.affiliation: 1 Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine , Boston, Massachusetts.
authors.forename: Ambili
authors.initials: A
authors.lastname: Ramachandran
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Bak
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Heeren
authors.forename: Clara A
authors.initials: CA
authors.lastname: Chen
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology; D003144:Communication Barriers; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D062526:Patient Navigation / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000523:psychology; D016387:Women's Health