Clinic Type and Patient Characteristics Affecting Time to Resolution After an Abnormal Cancer-screening Exam

Overview

Journal Cancer Epidemiol Biomarkers Prev

Specialties Biochemistry
Oncology
Public Health

Date 2014 Oct 15

PMID 25312997

Citations 4

Authors

Jessica L Krok-Schoen

Michelle L Kurta

Rory C Weier

Greg S Young

Autumn B Carey

Cathy M Tatum

Electra D Paskett

Affiliations

Soon will be listed here.

Abstract

Background: Research shows that multilevel factors influence healthcare delivery and patient outcomes. The study goal was to examine how clinic type [academic medical center (AMC) or federally qualified health center (FQHC)] and patient characteristics influence time to resolution (TTR) among individuals with an abnormal cancer-screening test enrolled in a patient navigation (PN) intervention.

Methods: Data were obtained from the Ohio Patient Navigation Research Project, a group-randomized trial of 862 patients from 18 clinics in Columbus, Ohio. TTR of patient after an abnormal breast, cervical, or colorectal screening test and the clinics' patient and provider characteristics were obtained. Descriptive statistics and Cox shared frailty proportional hazards regression models of TTR were used.

Results: The mean patient age was 44.8 years and 71% of patients were white. In models adjusted for study arm, FQHC patients had a 39% lower rate of resolution than AMC patients (P = 0.004). Patient factors of having a college education, private insurance, higher income, and being older were significantly associated with lower TTR. After adjustment for factors that substantially affected the effect of clinic type (patient insurance status, education level, and age), clinic type was not significantly associated with TTR.

Conclusions: These results suggest that TTR among individuals participating in PN programs are influenced by multiple socioeconomic patient-level factors rather than clinic type. Consequently, PN interventions should be tailored to address socioeconomic status factors that influence TTR.

Impact: These results provide clues regarding where to target PN interventions and the importance of recognizing predictors of TTR according to clinic type.

Citing Articles

Delays in Follow-up Care for Abnormal Mammograms in Mobile Mammography Versus Fixed-Clinic Patients.

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Effects of program scale-up on time to resolution for patients with abnormal screening mammography results.

Lee S, Higashi R, Sanders J, Zhu H, Inrig S, Mejias C Cancer Causes Control. 2018; 29(10):995-1005.

PMID: 30140972 PMC: 6162097. DOI: 10.1007/s10552-018-1074-4.

A Comparison of Different Intensities of Patient Navigation After Abnormal Mammography.

Glassgow A, Molina Y, Kim S, Campbell R, Darnell J, Calhoun E Health Promot Pract. 2018; 20(6):914-921.

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Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems.

Chubak J, Garcia M, Burnett-Hartman A, Zheng Y, Corley D, Halm E Cancer Epidemiol Biomarkers Prev. 2016; 25(2):344-50.

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References

Wu X, Lund M, Kimmick G, Richardson L, Sabatino S, Chen V . Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol. 2011; 30(2):142-50. DOI: 10.1200/JCO.2011.36.8399. View

Koh C, Nelson J, Cook P . Evaluation of a patient navigation program. Clin J Oncol Nurs. 2011; 15(1):41-8. DOI: 10.1188/11.CJON.41-48. View

Rosenberg R, Haneuse S, Geller B, Buist D, Miglioretti D, Brenner R . Timeliness of follow-up after abnormal screening mammogram: variability of facilities. Radiology. 2011; 261(2):404-13. PMC: 3198220. DOI: 10.1148/radiol.11102472. View

Bastani R, Mojica C, Berman B, Ganz P . Low-income women with abnormal breast findings: results of a randomized trial to increase rates of diagnostic resolution. Cancer Epidemiol Biomarkers Prev. 2010; 19(8):1927-36. DOI: 10.1158/1055-9965.EPI-09-0481. View

DOrsi C, Tu S, Nakano C, Carney P, Abraham L, Taplin S . Current realities of delivering mammography services in the community: do challenges with staffing and scheduling exist?. Radiology. 2005; 235(2):391-5. PMC: 3143037. DOI: 10.1148/radiol.2352040132. View

Karliner L, Ma L, Hofmann M, Kerlikowske K . Language barriers, location of care, and delays in follow-up of abnormal mammograms. Med Care. 2011; 50(2):171-8. PMC: 3918470. DOI: 10.1097/MLR.0b013e31822dcf2d. View

Palmer R, Samson R, Batra A, Triantis M, Mullan I . Breast cancer screening practices of safety net clinics: results of a needs assessment study. BMC Womens Health. 2011; 11:9. PMC: 3080315. DOI: 10.1186/1472-6874-11-9. View

Slone S, White C, Shelton B, Van Meter E, DeSimone C, Schoenberg N . Inconsistencies between medical records and patient-reported recommendations for follow-up after abnormal Pap tests. J Womens Health (Larchmt). 2012; 22(2):147-52. PMC: 3573725. DOI: 10.1089/jwh.2011.3414. View

Lowe R, Russell Localio A, Schwarz D, Williams S, Tuton L, Maroney S . Association between primary care practice characteristics and emergency department use in a medicaid managed care organization. Med Care. 2005; 43(8):792-800. DOI: 10.1097/01.mlr.0000170413.60054.54. View

10.

Allen C, Harris J, Hannon P, Parrish A, Hammerback K, Craft J . Opportunities for improving cancer prevention at federally qualified health centers. J Cancer Educ. 2013; 29(1):30-7. PMC: 3920058. DOI: 10.1007/s13187-013-0535-4. View

11.

Tejeda S, Darnell J, Cho Y, Stolley M, Markossian T, Calhoun E . Patient barriers to follow-up care for breast and cervical cancer abnormalities. J Womens Health (Larchmt). 2013; 22(6):507-17. PMC: 3678568. DOI: 10.1089/jwh.2012.3590. View

12.

Lin C, Schwaderer K, Morgenlander K, Ricci E, Hoffman L, Martz E . Factors associated with patient navigators' time spent on reducing barriers to cancer treatment. J Natl Med Assoc. 2008; 100(11):1290-7. DOI: 10.1016/s0027-9684(15)31507-8. View

13.

Strzelczyk J, Dignan M . Disparities in adherence to recommended followup on screening mammography: interaction of sociodemographic factors. Ethn Dis. 2002; 12(1):77-86. View

14.

Elizabeth Goldman L, Walker R, Hubbard R, Kerlikowske K . Timeliness of abnormal screening and diagnostic mammography follow-up at facilities serving vulnerable women. Med Care. 2013; 51(4):307-14. PMC: 3966312. DOI: 10.1097/MLR.0b013e318280f04c. View

15.

Yabroff K, Breen N, Vernon S, Meissner H, Freedman A, Ballard-Barbash R . What factors are associated with diagnostic follow-up after abnormal mammograms? Findings from a U.S. National Survey. Cancer Epidemiol Biomarkers Prev. 2004; 13(5):723-32. View

16.

Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P . Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2007; 58(1):9-31. DOI: 10.3322/CA.2007.0011. View

17.

Artz D, Brown M, Barrett M . The supply of mammography resources in West Virginia. W V Med J. 1992; 88(4):142-6. View

18.

Yabroff K, Washington K, Leader A, Neilson E, Mandelblatt J . Is the promise of cancer-screening programs being compromised? Quality of follow-up care after abnormal screening results. Med Care Res Rev. 2003; 60(3):294-331. DOI: 10.1177/1077558703254698. View

19.

Ayanian J, Kohler B, Abe T, Epstein A . The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993; 329(5):326-31. DOI: 10.1056/NEJM199307293290507. View

20.

Kerlikowske K . Timeliness of follow-up after abnormal screening mammography. Breast Cancer Res Treat. 1996; 40(1):53-64. DOI: 10.1007/BF01806002. View