Timeliness and Completeness of Care as Quality Measures: The Effect of Nurse Navigation on Breast Cancer Patients in a Comprehensive Cancer Center 公开

Basu, Mohua (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/zw12z5884?locale=zh
Published

Abstract


Objective: Patient navigation has been shown to improve timely care in cancer patients.
The current quality control study seeks to compare timeliness in the interval from breast
cancer diagnosis to initial oncology consultation for a nine-month period prior to and
during a nurse navigation intervention at Winship Cancer Institute. The study also seeks
to compare completeness of care for patients prior to and during the intervention.
Methods: Navigation services were initiated in July, 2010. All breast cancer patients
internally diagnosed with DCIS and Stage I-III disease were identified. Patients in the
non-navigated group (diagnosed between October 2009 and June 2010) were compared
to patients in the navigation group (diagnosed between October 2010 and June 2011).
Time from date of diagnosis to date of initial oncology consultation was measured in
days, excluding holidays/weekends. For patients receiving chemotherapy as initial
treatment, completeness of care was measured by comparing the proportion of patients
prior to and during the intervention who received consultations with three specialists
(surgical, medical, and radiation oncologist) before beginning treatment.
Results: Overall, 176 patients met inclusion criteria for analysis of timeliness (100 in
the non-navigation group and 76 in the navigation group). After controlling for
demographic and clinical factors, navigation was found to significantly improve time to
consultation for patients in the older age group (age 61+) ( p=.0002). For patients 61+,
average time to consultation was 13.4 days for non-navigated patients compared to 8.7
days for navigated patients. There was no significant improvement in timeliness for
patients in the younger age group (age 31-60). Navigation did not significantly improve
completeness of care, but this measure included a small sample (n=27).
Discussion: The navigation intervention significantly improved time to consultation
for older patients, but not younger patients. Older patients may have greater difficulty
navigating the health care system, so navigation had a greater impact on this population.
While a reduction of five days in time to consultation may not be clinically significant,
empirically measuring timeliness and completeness of care is crucial for identifying
delays in cancer care and allows for a more targeted intervention in the future.

Table of Contents



Table of Contents
Background ......................................................................................................................... 1
Introduction

............................................................................................................................................. 1
Barriers to Care ....................................................................................................................................... 1
Patient Navigation ................................................................................................................................... 2
Quantitative Studies ................................................................................................................................ 4
Timeliness and Completeness of Care ..................................................................................................... 6
Nurse Navigation Program, Winship Cancer Institute ......................................................................... 7
Objectives ................................................................................................................................................. 8

Methods ............................................................................................................................. 9
Patient Population ................................................................................................................................... 9
Data Collection ....................................................................................................................................... 10
Study Variables ...................................................................................................................................... 10
Data Analysis .......................................................................................................................................... 11

Results .............................................................................................................................. 12
Descriptive Statistics ............................................................................................................................. 12
Timeliness of Care .................................................................................................................................. 14
Completeness of Care ............................................................................................................................ 16

Discussion ......................................................................................................................... 16
Timeliness of Care .................................................................................................................................. 16
Completeness of Care ............................................................................................................................ 18
Limitations ............................................................................................................................................. 18
Conclusions ............................................................................................................................................20

References ........................................................................................................................ 21

List of Tables
Table 1: Patient Characteristics by Navigation Group ............................................................................................. 25
Table 2: Patient Time to Consultation by Navigation Group ................................................................................... 26
Table 3: Simple Linear Regression of Predictors on Time to Consultation ............................................................ 27
Table 4: Multiple Linear Regression of Predictors on Time to Consultation (with all interaction
variables) .................................................................................................................................................................... 28
Table 5: Multiple Linear Regression of Predictors on Time to Consultation, Continuous age ............................. 29
Table 6: Multiple Linear Regression of Predictors on Time to Consultation, Categorical age .............................. 30
Table 7: Multiple Linear Regression of Predictors on Time to Consultation, Age <61 ........................................... 31
Table 8: Multiple Linear Regression of Predictors on Time to Consultation, Age 61+ ......................................... 32
Table 9: Logistic Regression of Navigation on Multidisciplinary Care ................................................................... 33

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