title: Patient Navigation in Medically Underserved Areas study design: A trial with implications for efficacy, effect modification, and full continuum assessment.
abstract: The Patient Navigation in Medically Underserved Areas study objectives are to assess if navigation improves: 1) care uptake and time to diagnosis; and 2) outcomes depending on patients' residential medically underserved area (MUA) status. Secondary objectives include the efficacy of navigation across 1) different points of the care continuum among patients diagnosed with breast cancer; and 2) multiple regular screening episodes among patients who did not obtain breast cancer diagnoses.
  
  
  
  Our randomized controlled trial was implemented in three community hospitals in South Chicago. Eligible participants were: 1) female, 2) 18+years old, 3) not pregnant, 4) referred from a primary care provider for a screening or diagnostic mammogram based on an abnormal clinical breast exam. Participants were randomized to 1) control care or 2) receive longitudinal navigation, through treatment if diagnosed with cancer or across multiple years if asymptomatic, by a lay health worker. Participants' residential areas were identified as: 1) established MUA (before 1998), 2) new MUA (after 1998), 3) eligible/but not designated as MUA, and 4) affluent/ineligible for MUA. Primary outcomes include days to initially recommended care after randomization and days to diagnosis for women with abnormal results. Secondary outcomes concern days to treatment initiation following a diagnosis and receipt of subsequent screening following normal/benign results.
  
  
  
  This intervention aims to assess the efficacy of patient navigation on breast cancer care uptake across the continuum. If effective, the program may improve rates of early cancer detection and breast cancer morbidity.
authors.affiliation: University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA. Electronic address: ymolin2@uic.edu.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Molina
authors.affiliation: University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Glassgow
authors.affiliation: University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA.
authors.forename: Sage J
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA.
authors.forename: Nerida M
authors.initials: NM
authors.lastname: Berrios
authors.affiliation: University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Pauls
authors.affiliation: University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA.
authors.forename: Karriem S
authors.initials: KS
authors.lastname: Watson
authors.affiliation: Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL 60660, USA.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Darnell
authors.affiliation: University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA; University of Arizona, 550 East Van Buren Street, Phoenix, AZ 85004, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Calhoun
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002641:Chicago; D055088:Early Detection of Cancer; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008327:Mammography; D008507:Medically Underserved Area; D062526:Patient Navigation / Q000379:methods*; D017060:Patient Satisfaction; D010808:Physical Examination; D013997:Time Factors