Improving Patient Outcomes Through System Navigation

通过系统导航改善患者治疗效果

• 批准号: 7123006
• 负责人: PETER Christian RAICH
• 金额: $ 61.71万
• 依托单位: DENVER HEALTH AND HOSPITAL AUTHORITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-15 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7123006
• 关键词: behavioral /social science research tag; breast neoplasms; clinical research; colorectal neoplasms; cooperative study; counseling; early diagnosis; health behavior; health care service availability; health care service evaluation; health disparity; health services research tag; human subject; medical indigency; medically underserved population; neoplasm /cancer diagnosis; neoplasm /cancer therapy; patient care management; prostate neoplasms; psychological aspect of cancer; satisfaction; social psychology; telemedicine; therapy compliance; urban area

DESCRIPTION (provided by applicant): The overall goal of this application is to address a national priority in cancer control research by developing and conducting a highly innovative patient navigation program from the point of abnormal screening test to treatment for breast, colorectal and prostate cancers. The major venue for this program of research will be the Denver Health Medical Center (DH), which is the single largest "safety net" health care system linked to a major metropolitan area in the Rocky Mountain Region. DH serves a large number of minority (75%) and underserved patients (almost half without insurance). Unique features of this research are: (1) testing for efficacy and cost-effectiveness a comprehensive patient navigator program that will extend an existing and exemplary community lay health worker demonstration project at DH (Community Voices); (2) combining this resource with a well-established telephone counseling service to specifically address patient-centered psychosocial barriers; and (3) integrating these components into a comprehensive patient navigator program within the context of the healthcare provider institution. The following specific aims will guide the evaluation of this program: (1) to reduce the time between an abnormal screening test for breast, colorectal and prostate cancers to a positive or negative pathologic diagnosis; (2) to reduce the time from a positive pathologic diagnosis of breast, colorectal or prostate cancers to the start of therapy; (3) to increase the proportion of these patients adhering to recommendations for care, including completion of additional diagnostic tests, consultation appointments, and completion of treatment; (4) to improve patient reported outcomes of medical self-efficacy, satisfaction with care and distress related to cancer diagnosis in a sample of individuals with a negative pathologic diagnosis and among all individuals with a positive pathologic diagnosis; and (5) to examine the cost-effectiveness and return on investment of patient navigation. Ultimately we will demonstrate the efficacy and assess the financial impact associated with the implementation of a comprehensive navigation program designed to address disparities in cancer-related outcomes among the poor and underserved

描述（由申请人提供）： 该应用程序的总体目标是通过开发和实施从异常筛查测试到乳腺癌、结直肠癌和前列腺癌治疗的高度创新的患者导航计划，解决癌症控制研究的国家优先事项。该研究计划的主要地点将是丹佛健康医疗中心 (DH)，该中心是与落基山区主要都市区相连的最大的单一“安全网”医疗保健系统。卫生署为大量少数族裔 (75%) 和服务不足的患者（几乎一半没有保险）提供服务。这项研究的独特之处在于：（1）测试综合患者导航计划的功效和成本效益，该计划将扩展卫生署（社区之声）现有的示范性社区非专业卫生工作者示范项目； (2) 将此资源与完善的电话咨询服务相结合，专门解决以患者为中心的社会心理障碍； (3) 将这些组件集成到医疗保健提供机构背景下的综合患者导航程序中。 以下具体目标将指导该计划的评估：（1）缩短乳腺癌、结直肠癌和前列腺癌筛查检测异常到病理诊断呈阳性或阴性之间的时间； (2) 缩短从乳腺癌、结直肠癌或前列腺癌的阳性病理诊断到开始治疗的时间； (3) 增加这些患者遵守护理建议的比例，包括完成额外的诊断测试、咨询预约和完成治疗； (4) 在病理诊断阴性的个体样本和所有病理诊断阳性的个体中，改善患者报告的医疗自我效能、护理满意度和与癌症诊断相关的痛苦的结果； (5) 检查患者导航的成本效益和投资回报。最终，我们将展示实施综合导航计划的有效性并评估其财务影响，该计划旨在解决穷人和服务不足的人群中癌症相关结果的差异