标题：Evaluating a Bilingual Patient Navigation Program for Uninsured Women With Abnormal Screening Tests for Breast and Cervical Cancer: Implications for Future Navigator Research
摘要：Objectives. The DuPage Patient Navigation Collaborative evaluated the Patient Navigation Research Program (PNRP) model for uninsured women receiving free breast or cervical cancer screening through the Illinois Breast and Cervical Cancer Program in DuPage County, Illinois. Methods. We used medical records review and patient surveys of 477 women to compare median follow-up times with external Illinois Breast and Cervical Cancer Program and Chicago PNRP benchmarks of performance. We examined the extent to which we mitigated community-defined timeliness risk factors for delayed follow-up, with a focus on Spanish-speaking participants. Results. Median follow-up time (29.0 days for breast and 56.5 days for cervical screening abnormalities) compared favorably to external benchmarks. Spanish-speaking patients had lower health literacy, lower patient activation, and more health care system distrust than did English-speaking patients, but despite the prevalence of timeliness risk factors, we observed no differences in likelihood of delayed (> 60 days) follow-up by language. Conclusions. Our successful replication and scaling of the PNRP navigation model to DuPage County illustrates a promising approach for future navigator research. Suburban DuPage County, Illinois, adjacent to Chicago’s Cook County, has a growing low-income, uninsured population. The majority of the uninsured DuPage adults are Latino recent immigrants, as the primary “port of entry” of immigrants in Illinois has shifted from Chicago proper to suburban counties including DuPage. Mirroring the national trend toward “suburbanization” of poverty, 1 DuPage has rapidly become more diverse over the past 2 decades and has seen a dramatic increase in the population living under the federal poverty level. 2 However, unlike urban Cook County, suburban DuPage County has only a thin health care safety net to meet the needs of low-income residents. In 2002, in response to the need for health care among uninsured residents, a coalition of community organizations, local hospitals, and the DuPage Health Department created the Access DuPage Program (AD) to provide primary care homes for uninsured residents, with care provided by federally qualified health centers, volunteer private physicians, and a volunteer-staffed community clinic. In 2009, as part of a longstanding community-based participatory research partnership, Northwestern University and AD investigators launched the DuPage Patient Navigation Collaborative (DPNC) to deploy the navigation model developed by the national Patient Navigation Research Program (PNRP). 3 The DPNC was designed to help uninsured women across DuPage County who had received free breast or cervical cancer screening tests from the Illinois Breast and Cervical Cancer Program (IBCCP) and had abnormal results. 4 The program was a response to DuPage community leaders’ concerns about the ability of low-income women to follow-up on abnormal results in a timely manner, and particular concerns about barriers (e.g., health literacy, low patient activation, language, and medical distrust) encountered by Spanish-speaking, uninsured, immigrant Latinas that may put them at higher risk for delayed follow-up. The objective of this study was to evaluate the PNRP model scaled to DuPage County. By using medical record reviews and comparative Chicago suburban county IBCCP utilization data, we assessed the extent to which patient navigation helped uninsured, low-income women obtain timely follow-up of abnormal breast and cervical cancer screening results. Because the DPNC navigated high-risk IBCCP enrollees, we present both DPNC and overall DuPage IBCCP follow-up times, and describe the timeliness of DPNC follow-up compared with both external IBCCP and Chicago PNRP median follow-up times for low-income women with abnormal cancer screening tests. According to a priori importance to our community partners, we used patient survey data to analyze the extent to which DPNC navigators mitigated risk factors for delayed follow-up, including low health literacy, health care system distrust, low patient activation, and physical and mental health difficulties. Our analysis focused on whether significant differences exist between Spanish- and English-speaking patients after we controlled for other measures of risk for delay. Findings from DuPage illustrate an approach to replicating and scaling the PNRP navigation model in the context of maximizing community benefits.
