title: Effect of patient navigator program on no-show rates at an academic referral colposcopy clinic.
abstract: BACKGROUND
  Patient navigators have been used successfully to guide vulnerable patients through barriers to cancer care and reduce disparities in cancer outcomes. This study evaluated the effect of a patient navigator program on no-show rates at a tertiary care referral colposcopy center and explored factors associated with missed appointments.
  
  
  METHODS
  No-show rates prior and subsequent to implementation of the intervention were compared by chi-square test. We compared patient demographic, lifestyle, and diagnostic characteristics between patients who had ever and never missed appointments. We described patient-reported barriers to care.
  
  
  RESULTS
  Of 4,199 women evaluated in our clinic from January 2006 to December 2013, 2,441 (58%) had at least one missed appointment. African American, Hispanic, and publicly insured women tended to miss appointments more frequently than did white and privately insured women (p<0.0001). Patients who missed appointments tended to have more abnormal cytology (p<0.0001), cervical pathology (p=0.007), and vulvar pathology (p=0.001). No-show rates declined from 49.7% to 29.5% after implementation of the patient navigator program (p<0.0001). We found that 45% of patient no-shows were anticipated or a result of patient misunderstanding and could be mediated with targeted education by the patient navigator.
  
  
  CONCLUSIONS
  Patient navigator programs at referral centers reduce no-show rates, thus improving patient follow-up, which may reduce disparities in cervical cancer screening and treatment.
authors.affiliation: 1 Department of Obstetrics and Gynecology, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Luckett
authors.affiliation: 2 Department of Gynecologic Oncology, Dana Farber Cancer Institute , Harvard Medical School, Boston, Massachusetts.
authors.forename: Nancy
authors.initials: N
authors.lastname: Pena
authors.affiliation: 1 Department of Obstetrics and Gynecology, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Allison
authors.initials: A
authors.lastname: Vitonis
authors.affiliation: 2 Department of Gynecologic Oncology, Dana Farber Cancer Institute , Harvard Medical School, Boston, Massachusetts.
authors.forename: Marilyn R
authors.initials: MR
authors.lastname: Bernstein
authors.affiliation: 1 Department of Obstetrics and Gynecology, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Sarah
authors.initials: S
authors.lastname: Feldman
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D001071:Appointments and Schedules; D044383:Black People / Q000523:psychology; D003127:Colposcopy / Q000523:psychology*; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology; D006784:Hospitals, Teaching; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data*; D062526:Patient Navigation; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*