Abstract B90: The District of Columbia citywide Patient Navigation Research Program (DC-PNRP): Preliminary descriptive findings
Authors: Patierno Steven R , LaVerda Nancy L. , Hoffman Heather J. , Alexander Lisa M. , Levine Paul H. , Young Heather A. 
Published: December 2010

Introduction: Minority breast cancer mortality rates in Washington, DC are among the Nation's highest. To address these disparities we instituted the DC Citywide Patient Navigation Research Program (DC-PNRP) - an inter-institutional collaboration that is one of 9 National PNRP sites funded by NCI/ACS to evaluate the effectiveness of patient navigation in reducing time from suspicious finding to diagnostic resolution and time from resolution to treatment initiation.

Study Procedures: A total of 1024 women, mostly minorities, have been enrolled from 8 recruitment sites at the point of suspicious finding. Utilizing a non-randomized design, 1240 concurrent, medical records-based controls were identified from 6 sites for comparison. Subject recruitment ended March 31,2010, but data collection continues on those women already enrolled. A unique framework of “network navigation” emerged whereby services were integrated across a city-wide network of unaffiliated healthcare sites. Navigators from a broad partnership of clinical and community sites were trained to work collaboratively within a city-wide network to enroll patients in the study and assure each receives timely, quality care. This “integrative navigation”model is collecting data addressing not only structural barriers to access to care (i.e., inadequate insurance, lack of transportation, etc.), but also psychosocial barriers (i.e., fear, medical mistrust, acculturation, etc.). Frequent trainings, efforts that promote increased communication between navigators, and sharing of information about community resources were implemented to enhance care coordination and to assure appropriate referral strategies between community outreach, screening, and treatment sites.

Results and Conclusion: Among controls, 7.66% were non-Hispanic whites (NHW), 35.24% were non-Hispanic blacks (NHB), 30.65% were Hispanic, and 26.45% were of other or unknown race/ethnicity. The corresponding percentages for navigated patients were 7.03%, 48.93%, 29.88%, and 14.16% indicating larger numbers of NHB and fewer with other/unknown race/ethnicity among the navigated patients. When examining age of subjects grouped by &lt;40 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, and &gt;=80 years, respective proportions among controls were 7.10%, 37.98,28.15,16.29, 6.61, and 3.87%, while the distribution for navigated patients was: 20.70%, 32.03,24.41,14.06,5.57, and 3.22%, respectively, suggesting that navigated patients were slightly younger than controls. Household income level was generally unavailable for controls and for 35.54% of navigated patients. Proportions of navigated patients falling into the income categories &lt;$10,000, $10-19,999, $20-29,999, $30-39,999, $40-49,999, and &gt;=$50,000 are 14.06%, 13.38,9.38,9.18,4.59, and 13.87%, respectively, indicating fairly substantial numbers of low income patients. Among controls, 29.27% indicated they had no form of health insurance. The proportion was similar for navigated patients at 33.98%. Our data indicate we have comparable groups based on demographic attributes of navigated and control patients for our future analyses.

Funding Mechanism: Grant Number 1 U01 CA116937; Patient Navigation Research Program (PNRP), Center for Research on Cancer Health Disparities (CRCHD), National Cancer Institute (NCI).

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B90.