title: Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening.
abstract: OBJECTIVE
  As part of the Patient Navigation Research Program, we examined the effect of patient navigation versus usual care on timely diagnostic follow-up, defined as clinical management for women with cervical abnormalities within accepted time frames.
  
  
  METHODS
  Participants from four Patient Navigation Research Program centers were divided into low- and high-risk abnormality groups and analyzed separately. Low-risk participants (n = 2088) were those who enrolled with an initial Pap test finding of atypical squamous cells of undetermined significance (ASCUS) with a positive high-risk human papillomavirus (HPV) serotype, atypical glandular cells, or low-grade squamous intraepithelial lesion (LGSIL). High-risk participants were those with an initial finding of high-grade squamous intraepithelial lesion (HGSIL) (n = 229). A dichotomous outcome of timely diagnostic follow-up within 180 days was used for the low-risk abnormality group and timely diagnostic follow-up within 60 days for the high-risk group, consistent with treatment guidelines. A logistic mixed-effects regression model was used to evaluate the intervention effect using a random effect for study arm within an institution. A backward selection process was used for multivariable model building, considering the impact of each predictor on the intervention effect.
  
  
  RESULTS
  Low-risk women in the patient navigation arm showed an improvement in the odds of timely diagnostic follow-up across all racial groups, but statistically significant effects were only observed in non-English-speaking Hispanics (OR 5.88, 95% CI 2.81-12.29). No effect was observed among high-risk women.
  
  
  CONCLUSIONS
  These results suggest that patient navigation can improve timely diagnostic follow-up among women with low-risk cervical abnormalities, particularly in non-English-speaking Hispanic women.
authors.affiliation: 1 Division of Cancer Prevention and Control, Ohio State University , Columbus, Ohio.|2 Comprehensive Cancer Center, Ohio State University , Columbus, Ohio.
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.affiliation: 3 Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio , San Antonio, Texas.
authors.forename: Donald
authors.initials: D
authors.lastname: Dudley
authors.affiliation: 4 Center for Biostatistics, Ohio State University , Columbus, Ohio.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Young
authors.affiliation: 2 Comprehensive Cancer Center, Ohio State University , Columbus, Ohio.
authors.forename: Brittany M
authors.initials: BM
authors.lastname: Bernardo
authors.affiliation: 5 Department of Psychology, San Diego State University , San Diego, California.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Wells
authors.affiliation: 6 Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Calhoun
authors.affiliation: 7 Division of Oncology, Department of Family Medicine, Community, and Preventive Medicine, James P. Wilmont Cancer Center, University of Rochester , Rochester, New York.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.affiliation: 8 George Washington University Cancer Institute , Washington, DC.|9 Duke Cancer Institute , Durham, North Carolina.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Patierno
authors.affiliation: 10 Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center , Portland, Oregon.
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.affiliation: 11 Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine , Boston, Massachusetts.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis*; D062526:Patient Navigation; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*