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Background: Patient navigation--the provision of logistical, educational, and emotional support needed to help patients "navigate around" barriers to high-quality cancer treatment offers promise. No patient-reported outcome measures currently exist that assess patient navigation from the patient's perspective. We use a partial independence item response theory model to report on the psychometric properties of the Patient Satisfaction with Navigation, Logistical measure developed for this purpose., Methods: We used data from an ethnically diverse sample (n = 1873) from the National Cancer Institute Patient Navigation Research Program. We included individuals with the presence of an abnormal breast, cervical, colorectal, or prostate cancer finding., Results: The partial independence item response theory model fit well. Results indicated that scores derived from responses provide extremely precise and reliable measurement between -2.5 SD below and 2 SD above the mean and acceptably precise and reliable measurement across nearly the entire range., Conclusions: Our findings provide evidence in support of the Patient Satisfaction with Navigation, Logistical. Scale users should utilize 1 of the 2 described methods to create scores.

Patient navigation requires that patient load be equitably distributed. We examined whether navigators could predict the relative amount of time needed by different patients for navigation. Analysis of 139 breast and colorectal cancer patients randomized to the navigation arm of a trial evaluating the effectiveness of navigation. Navigators completed a one-item scale estimating how much navigation time patients were likely to require. Participants were mostly females (89.2%) with breast cancer (83.4%); barriers to cancer care were insurance difficulties (26.6%), social support (18.0%), and transportation (14.4%). Navigator baseline estimates of navigation intensity predicted total navigation time, independent of patient characteristics. The total number of barriers, rather than any specific type of barrier, predicted increased navigator time, with a 16% increase for each barrier. Navigators' estimate of intensity independently predicts navigation time for cancer patients. Findings have implications for assigning navigator case loads.

Background: Patient-reported outcomes (PROs) are measures completed by patients to capture outcomes that are meaningful and valued by patients. To help standardize PRO measures in patient navigation research and program evaluation, the Patient-Reported Outcomes Working Group (PROWG) was convened as part of the American Cancer Society's National Patient Navigator Leadership Summit., Methods: The PROWG consisted of clinicians, researchers, and program managers from a variety of perspectives who developed a set of recommended PRO measures across the cancer continuum (ie, screening, diagnostic follow-up, treatment, survivorship, end of life) as well as those useful for assessing family caregivers. Measures were recommended based on face validity, responsiveness to navigation, reliability, and construct validity in relevant populations. Other considerations included readability, existence of multiple language versions, the existence of norm groups, and respondent burden., Results: The PROWG reached consensus on measures for use in the domains of treatment adherence; perceived barriers to care; satisfaction with cancer care; satisfaction with patient navigation services; working alliance with patient navigator; perceived knowledge/competence/self-efficacy; functional assessment/symptom burden; global quality of life; specific quality-of-life symptoms (eg, depression, anxiety); and perceived cultural competency of the navigator. In domains where validated measures were found lacking, recommendations were made for areas of needed scale development., Conclusions: These measures should guide research and programmatic evaluation of patient navigation., (Copyright © 2011 American Cancer Society.)

Objective: To investigate whether having a usual source of care (USOC) resulted in lower depression prevalence among the elderly., Data Sources: The 2001-2003 Medicare Current Beneficiaries Survey and 2002 Area Resource File., Study Design: Twenty thousand four hundred and fifty-five community-dwelling person-years were identified for respondents aged 65+, covered by both Medicare Parts A and B in Medicare fee-for-service for a full year. USOC was defined by the question "Is there a particular medical person or a clinic you usually go to when you are sick or for advice about your health?" Ambulatory care use (ACU) was defined by having at least one physician office visit and/or hospital outpatient visit using Medicare claims. Depression was identified by a two-item screen (sadness and/or anhedonia). All measures were for the past 12 months. A simultaneous-equations (trivariate probit) model was estimated, adjusted for sampling weights and study design effects., Principal Findings: Based on the simultaneous-equations model, USOC is associated with 3.8 percent lower probability of having depression symptoms (p=.03). Also, it had a positive effect on having any ACU (p<.001). Having any ACU had no statistically significant effect on depression (p=.96)., Conclusions: USOC was associated with lower depression prevalence and higher realized access (ACU) among community-dwelling Medicare beneficiaries., (© Health Research and Educational Trust.)

Background: Racial minorities have poorer cancer survival in the United States compared to whites. The purpose of this study was to better understand patients' barriers to cancer care and to determine which patients have a greater need for assistance from a patient navigator., Methods: Community health workers assisted newly-diagnosed breast and colorectal cancer patients during a randomized trial of patient navigation and collected information about patients' barriers. Barriers to care were characterized and compared between non-Hispanic white and minority patients. A multivariate model was constructed of factors associated with increased log navigation time, a measure of patients' need for assistance., Results: Patients' (n = 103) most commonly identified barriers to care included a lack of social support, insurance/financial concerns, and problems communicating with health care providers. Barriers differed between nonminority and minority patients, and minority patients faced a greater number of barriers (p = .0001). In univariate analysis, log navigation time was associated with race/ethnicity, education, income, employment, insurance type, health literacy, marital status, language, and comorbidity. A multivariate model (R2 = 0.43) for log navigation time was created using stepwise selection, and included the following factors: minority race/ethnicity (p = .032), non-full-time employment (p = .0004), unmarried status (p = .085), university center (p = .0005), and months in study (p <.0001)., Conclusions: Newly diagnosed cancer patients' most common barriers to care include lack of social support, insurance/financial concerns, and problems with health care communications. In this sample of patients, a greater need for assistance was independently associated with minority race/ethnicity and unemployment. These data may help in the design and targeting of interventions to reduce cancer health disparities.

Objective: Patient navigation for cancer care assesses and alleviates barriers to health care services. We examined paired perspectives of cancer patients and their navigators to examine the process of patient navigation. We explored the strengths, limitations, and our own lessons learned about adopting the novel methodology of multiperspective analysis., Methods: As part of a larger RCT, patients and navigators were interviewed separately. We reviewed interviews with 18 patient-navigator dyads. Dyad summaries were created that explicitly incorporated both patient and navigator perspectives. Emerging themes and verbatim quotations were reflected in the summaries., Results: Paired perspectives were valuable in identifying struggles that arose during navigation. These were represented as imbalanced investment and relational amelioration. Patients and navigators had general consensus about important patient needs for cancer care, but characterized these needs differently., Conclusion: Our experience with multiperspective analysis revealed a methodology that delivers novel relational findings, but is best conducted de novo rather than as part of a larger study., Practice Implications: Multiperspective analysis should be more widely adopted with clear aims and analytic strategy that strengthen the ability to reveal relational dynamics. Navigation training programs should anticipate navigator struggles and provide navigators with tools to manage them., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Patient navigation (PN) programs are being widely implemented to reduce disparities in cancer care for racial/ethnic minorities and the poor. However, few systematic studies cogently describe the processes of PN. We qualitatively analyzed 21 transcripts of semistructured exit interviews with three navigators about their experiences with patients who completed a randomized trial of PN. We iteratively discussed codes/categories, reflective remarks, and ways to focus/organize data and developed rules for summarizing data. We followed a three-stage analysis model: reduction, display, and conclusion drawing/verification. We used ATLAS.ti&#95;5.2 for text segmentation, coding, and retrieval. Four categories of factors affecting cancer care outcomes emerged: patients, navigators, navigation processes, and external factors. These categories formed a preliminary conceptual framework describing ways in which PN processes influenced outcomes. Relationships between processes and outcomes were influenced by patient, navigator, and external factors. The process of PN has at its core relationship-building and instrumental assistance. An enhanced understanding of the process of PN derived from our analyses will facilitate improvement in navigators' training and rational design of new PN programs to reduce disparities in cancer-related care.

Objective: We examined how navigation, defined as the assessment and alleviation of barriers to adequate health care, influences patients' perspectives on the quality of their cancer care., Methods: We conducted post-study patient interviews from a randomized controlled trial (usual care vs. patient navigation services) from cancer diagnosis through treatment completion. Patients were recruited from 11 primary care, hospital and community oncology practices in New York. We interviewed patients about their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance., Results: Thirty-five patients newly diagnosed with breast or colorectal cancer. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving, and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to usual care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support., Conclusion: Cancer patients value navigation. Instrumental benefits were the most important expectations for navigation from navigated and non-navigated patients. Navigated patients received emotional support and assistance with information needs, problem-solving, and logistical aspects of cancer care coordination., Practice Implications: Navigation services may help improve cancer care outcomes important to patients by addressing fragmented, confusing, uncoordinated, or inefficient care., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Patient navigators-individuals who assist patients through the healthcare system to improve access to and understanding of their health and healthcare-are increasingly used for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost-effective. In the current study, the authors outline a conceptual model for evaluating the cost-effectiveness of cancer navigation programs. They describe how this model is being applied to the Patient Navigation Research Program, a multicenter study supported by the National Cancer Institute's Center to Reduce Cancer Health Disparities. The Patient Navigation Research Program is testing navigation interventions that aim to reduce time to delivery of quality cancer care (noncancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost-effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relation between navigation programs and outcome of interest (eg, improving access to prompt diagnostic resolution and life-years gained), and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, the authors discuss several strategies for addressing these barriers. Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations concerning dissemination of navigation programs., ((c) 2009 American Cancer Society.)

Objective: To review two indirect methods, geocoding and surname analysis, for estimating race/ethnicity as a means for health plans to assess disparities in care., Study Design: Review of published articles and unpublished data on the use of geocoding and surname analyses., Principal Findings: Few published studies have evaluated use of geocoding to estimate racial and ethnic characteristics of a patient population or to assess disparities in health care. Three of four studies showed similar estimates of the proportion of blacks and one showed nearly identical estimates of racial disparities, regardless of whether indirect or more direct measures (e.g., death certificate or CMS data) were used. However, accuracy depended on racial segregation levels in the population and region assessed and geocoding was unreliable for identifying Hispanics and Asians/Pacific Islanders. Similarly, several studies suggest surname analyses produces reasonable estimates of whether an enrollee is Hispanic or Asian/Pacific Islander and can identify disparities in care. However, accuracy depends on the concentrations of Asians or Hispanics in areas assessed. It is less accurate for women and more acculturated and higher SES persons due intermarriage, name changes, and adoption. Surname analysis is not accurate for identifying African Americans. Recent unpublished analyses suggest plans can successfully use a combined geocoding/surname analyses approach to identify disparities in care in most regions. Refinements based on Bayesian methods may make geocoding/surname analyses appropriate for use in areas where the accuracy is currently poor, but validation of these preliminary results is needed., Conclusions: Geocoding and surname analysis show promise for estimating racial/ethnic health plan composition of enrollees when direct data on major racial and ethnic groups are lacking. These data can be used to assess disparities in care, pending availability of self-reported race/ethnicity data.

Health is unevenly distributed across socioeconomic status. Persons of lower income, education, or occupational status experience worse health and die earlier than do their better-off counterparts. This article discusses these disparities in the context of urban medical practice. The article begins with a discussion of the complex relationship among socioeconomic status, race, and health in the United States. It highlights the effects of institutional, individual, and internalized racism on the health of African Americans, including the insidious consequences of residential segregation and concentrated poverty. Next, the article reviews health disparities based on socioeconomic status across the life cycle, beginning in fetal health and ending with disparities among the elderly. Potential explanations for these socioeconomic-based disparities are addressed, including reverse causality (e.g., being poor causes lower socioeconomic status) and confounding by genetic factors. The article underscores social causation as the primary explanation for health disparities and highlights the cumulative effects of social disadvantage across stages of the life cycle and across environments (e.g., fetal, family, educational, occupational, and neighborhood). The article concludes with a discussion of the implications of health disparities for the practice of urban medicine, including the role that concentration of disadvantage plays among patients and practice sites and the need for quality improvement to mitigate these disparities.

Background: Racial and ethnic disparities in health care have been well documented, but poorly explained., Objective: To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care., Research Design: Cross-sectional analysis of the Community Tracking Survey (1996-1997)., Subjects: Adults 18 to 64 years with private or Medicaid health insurance., Measures: Independent variables included race, ethnicity, and English fluency. Dependent variables included having had a physician or mental health visit, influenza vaccination, or mammogram during the past year., Results: The health care use pattern for English-speaking Hispanic patients was not significantly different than for non-Hispanic white patients in the crude or multivariate models. In contrast, Spanish-speaking Hispanic patients were significantly less likely than non-Hispanic white patients to have had a physician visit (RR, 0.77; 95% CI, 0.72-0.83), mental health visit (RR, 0.50; 95% CI, 0.32-0.76), or influenza vaccination (RR, 0.30; 95% CI, 0.15-0.52). After adjustment for predisposing, need, and enabling factors, Spanish-speaking Hispanic patients showed significantly lower use than non-Hispanic white patients across all four measures. Black patients had a significantly lower crude relative risk of having received an influenza vaccination (RR, 0.73; 95% CI, 0.58-0.87). Adjustment for additional factors had little impact on this effect, but resulted in black patients being significantly less likely than non-Hispanic white patients to have had a visit with a mental health professional (RR, 0.46; 95% CI, 0.37-0.55)., Conclusions: Among insured nonelderly adults, there are appreciable disparities in health-care use by race and Hispanic ethnicity. Ethnic disparities in care are largely explained by differences in English fluency, but racial disparities in care are not explained by commonly used access factors.

Objectives: Although early-life dental care is crucial for preventing early childhood caries and has numerous benefits, the utilization rate of such care remains remarkably low worldwide, especially in families of low socioeconomic status. The aim of this study was to systematically review the scientific evidence relating to the effectiveness of interventions on improving early-life dental care utilization of very young children. Method and materials: Scientific evidence relating to these positive changes was reviewed, with seven randomized controlled trials after qualitative evaluation. Interventions assessed included prenatal oral health promotion, motivational interviewing, intra-oral camera use alongside social work consultations to aid in decreasing barriers to care, monetary incentives for tooth brushing, fluoride varnish applications, and probiotic usage. Results: The intervention was significantly effective in reducing the incidence of dental caries among children, especially in caries risk. Caries reduction was significant when oral health information was provided at frequent intervals prena-tally. Caries increment was also reduced when probiotics were introduced when administered daily. Interventions that attempted to increase parental involvement in oral health care by increasing motivation and decreasing barriers had inconclusive results within the study groups. Conclusions: Considering high rates of early childhood caries, early establishment and preservation of a dental home should be a focus in public health measures. Continuous monitoring and parental involvement are key components to maintaining healthy oral conditions. Future studies could explore and test various innovative strategies that utilize technological platforms to engage with parents and promote early-life dental care utilization among the underserved population. [ABSTRACT FROM AUTHOR]

BackgroundWhether patient socio-demographic characteristics (age, sex, race/ethnicity, income, and education) are independently associated with failure to receive indicated statin therapy and/or to achieve low density lipoprotein cholesterol (LDL-C) therapy goals are not known. We examined socio-demographic factors associated with a) eligibility for statin therapy among those not on statins, and b) achievement of statin therapy goals.MethodsAdults (21-79 years) participating in the United States (US) National Health and Nutrition Examination Surveys, 1999-2006 were studied. Statin eligibility and achievement of target LDL-C was assessed using the US Third Adult Treatment Panel (ATP III) on Treatment of High Cholesterol guidelines.ResultsAmong 6,043 participants not taking statins, 10.4% were eligible. Adjusted predictors of statin eligibility among statin non-users were being older, male, poorer, and less educated. Hispanics were less likely to be eligible but not using statins, an effect that became non-significant with adjustment for language usually spoken at home. Among 537 persons taking statins, 81% were at LDL-C goal. Adjusted predictors of goal failure among statin users were being male and poorer. These risks were not attenuated by adjustment for healthcare access or utilization.ConclusionAmong person's not taking statins, the socio-economically disadvantaged are more likely to be eligible and among those on statins, the socio-economically disadvantaged are less likely to achieve statin treatment goals. Further study is needed to identify specific amenable patient and/or physician factors that contribute to these disparities.

Policy PointsThe meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity.Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high‐quality primary care.The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action. [ABSTRACT FROM AUTHOR]

The article presents the discussion on addressing health equity starting at home. Topics include diagnostic terms and associated words having potential unintended consequences of harming people and contributing to social injustice; and offering little resistance while simultaneously shielding police from accountability.

The United States is in the midst of a health crisis marked by unprecedented 3-year declines in life expectancy. Addressing this national crisis requires alignment of public policies, public health policies, and health care policies, with the overarching aim of improving national health and health equity. Aligning national polices to support human needs provides a foundation for implementing post--Affordable Care Act national health care reform. Reform should start with the twin goals of improving health care value and equity. A focus on value, that is, outcomes and processes desired by patients, is critical to ensuring that resources are judiciously deployed to optimize individual and population health. A focus on health care equity ensures that the health care system is intentionally designed to minimize inequities in health care processes and outcomes, particularly for member of socially disadvantaged groups. All sectors related to the health care system--from policies and payment mechanisms to delivery design, measurement, patient engagement/democratization, training, and research--should be tightly aligned with improving health care value and equity during this next era of health care reform. [ABSTRACT FROM AUTHOR]

Background: Racial disparities exist in the care provided to advanced cancer patients. This article describes an investigation designed to advance the science of healthcare disparities by isolating the effects of patient race and patient activation on physician behavior using novel standardized patient (SP) methodology.Methods/design: The Social and Behavioral Influences (SBI) Study is a National Cancer Institute sponsored trial conducted in Western New York State, Northern/Central Indiana, and lower Michigan. The trial uses an incomplete randomized block design, randomizing physicians to see patients who are either black or white and who are "typical" or "activated" (e.g., ask questions, express opinions, ask for clarification, etc.). The study will enroll 91 physicians.Discussion: The SBI study addresses important gaps in our knowledge about racial disparities and methods to reduce them in patients with advanced cancer by using standardized patient methodology. This study is innovative in aims, design, and methodology and will point the way to interventions that can reduce racial disparities and discrimination and draw links between implicit attitudes and physician behaviors.Trial Registration: https://clinicaltrials.gov/ , #NCT01501006, November 30, 2011. [ABSTRACT FROM AUTHOR]

Background: Patient navigation is a barrier-focused program of care coordination designed to achieve timely and high-quality cancer-related care for medically underserved racial-ethnic minorities and the poor. However, to the authors' knowledge, few studies to date have examined the relationship between satisfaction with navigators and cancer-related care.Methods: The authors included data from 1345 patients with abnormal cancer screening tests or a definitive cancer diagnosis who participated in the Patient Navigation Research Program to test the efficacy of patient navigation. Participants completed demographic questionnaires and measures of patient satisfaction with cancer-related care (PSCC) and patient satisfaction with interpersonal relationship with navigator (PSN-I). The authors obtained descriptive statistics to characterize the sample and conducted regression analyses to assess the degree of association between PSN-I and PSCC, controlling for demographic and clinical factors. Analyses of variance were conducted to examine group differences controlling for statistically significant covariates.Results: Statistically significant relationships were found between the PSCC and PSN-I for patients with abnormal cancer screening tests (1040 patients; correlation coefficient (r), 0.4 [P<.001]) and those with a definitive cancer diagnosis (305 patients; correlation coefficient, 0.4 [P<.001]). The regression analysis indicated that having an abnormal colorectal cancer screening test in the abnormal screening test group and increased age and minority race-ethnicity status in the cancer diagnosis group were associated with a higher satisfaction with cancer care (P<.01).Conclusions: Satisfaction with navigators appears to be significantly associated with satisfaction with cancer-related care. Information regarding the patient-navigator relationship should be integrated into patient navigation programs to maximize the likelihood of reducing caner disparities and mortality for medically underserved racial-ethnic minorities and the poor. [ABSTRACT FROM AUTHOR]

The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities. [ABSTRACT FROM AUTHOR]

Background: Patient empowerment represents a potent tool for addressing racial, ethnic and socioeconomic disparities in health care, particularly for chronic conditions such as HIV infection that require active patient engagement. This multimodal intervention, developed in concert with HIV patients and clinicians, aims to provide HIV patients with the knowledge, skills, attitudes and tools to become more activated patients.Methods/design: Randomized controlled trial of a multimodal intervention designed to activate persons living with HIV. The intervention includes four components: 1) use of a web-enabled hand-held device (Apple iPod Touch) loaded with a Personal Health Record (ePHR) customized for HIV patients; 2) six 90-minute group-based training sessions in use of the device, internet and the ePHR; 3) a pre-visit coaching session; and 4) clinician education regarding how they can support activated patients. Outcome measures include pre- post changes in patient activation measure score (primary outcome), eHealth literacy, patient involvement in decision-making and care, medication adherence, preventive care, and HIV Viral Load.Discussion: We hypothesize that participants receiving the intervention will show greater improvement in empowerment and the intervention will reduce disparities in study outcomes. Disparities in these measures will be smaller than those in the usual care group. Findings have implications for activating persons living with HIV and for other marginalized groups living with chronic illness.Trial Registration: ClinicalTrials.gov Identifier: NCT02165735, 6/13/2014. [ABSTRACT FROM AUTHOR]

Abstract: We tested the hypothesis that racial differences in vitamin D levels are associated with racial disparities in insulin resistance between blacks and whites. Among 3628 non-Hispanic black and white adults in the National Health and Nutrition Examination Survey from 2001 to 2006, we examined the association between race and insulin resistance using the homeostasis assessment model for insulin resistance. We conducted analyses with and without serum 25-hydroxyvitamin D (25[OH]D). We adjusted for age, sex, educational level, body mass index, waist circumference, physical activity, alcohol intake, smoking, estimated glomerular filtration rate, and urinary albumin/creatinine ratio. Blacks had a lower mean serum 25(OH)D level compared with whites (14.6 [0.3] ng/mL vs 25.6 [0.4] ng/mL, respectively; P < .0001). Blacks had a higher odds ratio (OR) for insulin resistance without controlling for serum 25(OH)D levels (OR, 1.67; 95% confidence interval, 1.26-2.20). The association was not significant (OR, 1.28; 95% confidence interval, 0.90-1.82) after accounting for serum 25(OH)D levels. The higher burden of insulin resistance in blacks compared with whites may be partially mediated by the disparity in serum 25(OH)D levels. [Copyright &y& Elsevier]

Background Patient navigators are trained to help patients effectively access and use healthcare resources in order to facilitate timely completion of recommended cancer screening, diagnostic care, and treatment. Patient navigators provide logistic, instrumental, and psychosocial support to cancer patients. Yet few studies have examined patient-navigator relationships, particularly for Spanish-speaking patients with low English proficiency. We aimed to validate a Spanish version of the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I-Sp) scale. Methods We translated and back-translated the PSN-I into Spanish and administered the resulting PSN-I-Sp to 222 Spanish-fluent participants. We conducted a principal components analysis and assessed Cronbach's coefficient alpha ( α) to evaluate the latent structure and the internal consistency of the PSN-I-Sp. We also completed correlation analyses to examine divergence and convergence of the PSN-I-Sp with the Spanish version of the Patient Satisfaction with Cancer-Related Care (PSCC-Sp) and the patients' demographics. Results The principal components analysis revealed a one-dimensional PSN-I-Sp measure that explained 82.0% of the variance. The reliability assessment revealed high internal consistency ( α = 0.97). The PSN-I-Sp demonstrated good face validity and adequate convergent and divergent characteristics as indicated by a moderate correlation with scores on the PSCC-Sp (all ps < 0.0001) and a non-statistically significant correlation with marital status (all p > 0.05). Conclusion The PSN-I-Sp is a valid and internally consistent measure of satisfaction with interpersonal relationship with a patient navigator for Spanish-speaking participants. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: We examined the rural-urban disparity of screening for breast cancer and colorectal cancer (CRC) among the elder Medicare beneficiaries and assessed rurality's independent impact on receipt of screening. Methods: Using 2005 Medicare Current Beneficiary Survey, we applied weighted logistic regression to estimate the overall rural-urban disparity and rurality's independent impact on cancer screening, controlling for patient, and area factors. Results: From urban, large rural, small rural, and isolated rural areas, the rates for mammogram last year were 53%, 52%, 45%, and 44%, respectively. They were 56%, 50%, 48%, and 43% for CRC screening, respectively. After controlling for patient and area level characteristics, rurality is significantly associated with CRC screening, but not mammogram. Conclusions: We found rural-urban disparities for both mammogram and CRC screenings. Patient and area factors totally eliminated the rural-urban disparity for mammogram but not CRC screening. Health promotions to improve cancer screening should focus more on small and isolated rural areas. [ABSTRACT FROM AUTHOR]

Background: Patient, provider, and systems barriers contribute to delays in cancer care, a lower quality of care, and poorer outcomes in vulnerable populations, including low-income, underinsured, and racial/ethnic minority populations. Patient navigation is emerging as an intervention to address this problem, but navigation requires a clear definition and a rigorous testing of its effectiveness. Pilot programs have provided some evidence of benefit, but have been limited by evaluation of single-site interventions and varying definitions of navigation. To overcome these limitations, a 9-site National Cancer Institute Patient Navigation Research Program (PNRP) was initiated.Methods: The PNRP is charged with designing, implementing, and evaluating a generalizable patient navigation program targeting vulnerable populations. Through a formal committee structure, the PNRP has developed a definition of patient navigation and metrics to assess the process and outcomes of patient navigation in diverse settings, compared with concurrent continuous control groups.Results: The PNRP defines patient navigation as support and guidance offered to vulnerable persons with abnormal cancer screening or a cancer diagnosis, with the goal of overcoming barriers to timely, quality care. Primary outcomes of the PNRP are 1) time to diagnostic resolution; 2) time to initiation of cancer treatment; 3) patient satisfaction with care; and 4) cost effectiveness, for breast, cervical, colon/rectum, and/or prostate cancer.Conclusions: The metrics to assess the processes and outcomes of patient navigation have been developed for the NCI-sponsored PNRP. If the metrics are found to be valid and reliable, they may prove useful to other investigators. [ABSTRACT FROM AUTHOR]

Abstract: Purpose. : Racial and ethnic disparities in influenza vaccination among the elderly are well documented, but their impact on minority mortality is unknown. Methods. : We model racial and ethnic parity in influenza vaccination on reduction in annual minority deaths among the elderly using age-, sex-, race-, and ethnicity-specific influenza vaccination data from the 2002 Medicare Current Beneficiary Survey, national mortality data and a relative risk (0.89; 95% confidence interval 0.80–0.98) for all-cause mortality during influenza season associated with vaccination. We also estimate the impact of 90% influenza coverage (Healthy People 2010 objective) on annual minority and white deaths. Lastly, we estimate years of minority lives saved from parity in annual vaccination beginning at age 65. Results. : Parity in influenza vaccination would reduce elderly minority deaths by 1880 annually. Achievement of 90% vaccination coverage would reduce minority and White deaths by 3750 and 11,840 annually. Parity in vaccination beginning at age 65 and continuing through out life would save more than 33,000 minority years of life. Conclusions. : Based on conservative estimates, elimination of racial and ethnic disparities in influenza vaccination would significantly reduce elderly minority mortality and save substantial years of minority life. [Copyright &y& Elsevier]

Background: We wanted to examine how membership in a health maintenance organization (HMO) is related to delivery of preventive clinical services to patients with different educational levels.Methods: We conducted a cross-sectional analysis of the 1996-1997 Community Tracking Study Household Survey among adults aged 18 to 64 years with private or Medicaid health insurance. We examined interactions between respondent educational level and HMO membership for the following measures: having a regular source of care and, in the past year, having had a physician visit, a mental health visit, a mammogram (women > or = 50 years), an influenza vaccination (ages > or = 55 years), or smoking cessation counseling (smokers).Results: After adjustment for sociodemographic factors, community size, insurance type, physical and mental health status, and smoking, respondents with less education were significantly less likely to have had a physician visit or mental health visit, mammogram, or influenza vaccination in the past year. Disparities in receipt of preventive care by educational level were smaller among HMO members. Differences in disparities between HMO members and non-HMO members reached statistical significance for influenza vaccination and showed a trend for mental health visits (P = .06). Moreover, HMO members with less than 12 years of education received services at levels comparable to non-HMO members with more education.Conclusions: There are appreciable disparities in receipt of preventive care by education among nonelderly insured persons. HMO membership is associated with smaller disparities for some services. Those with the lowest levels of education appeared to benefit the most from HMO membership. [ABSTRACT FROM AUTHOR]

Reviews the socioeconomic, racial and ethnic disparities in health care quality in the United States. Failure of existing assessment measures to identify disparities; Principles for addressing disparities; Benefits of proposed principles; Challenges of implementation.

Background: Data on barriers and facilitators to prenatal oral health care among low-income US women are lacking. The objective of this study was to understand barriers/facilitators and patient-centered mitigation strategies related to the use of prenatal oral health care among underserved US women. Methods: We used community-based participatory research to conduct two focus groups with eight pregnant/parenting women; ten individual in-depth interviews with medical providers, dental providers and community/social workers; and one community engagement studio with five representative community stakeholders in 2018–2019. Using an interpretive description research design, we conducted semi-structured interviews and focus groups which were audio-recorded, transcribed, and analyzed for thematic content. Results: We identified individual and systemic barriers/facilitators to the utilization of prenatal oral health care by underserved US women. Strategies reported to improve utilization included healthcare system-wide changes to promote inter-professional collaborations, innovative educational programs to improve dissemination and implementation of prenatal oral health care guidelines, and specialized dental facilities providing prenatal oral health care to underserved women. Moreover, smartphones have the potential to be an innovative entry point to promote utilization of prenatal oral care at the individual level. Conclusions: Low-income women face multiple, addressable barriers to obtaining oral health care during pregnancy. Inter-professional collaboration holds strong promise for improving prenatal oral health care utilization. [ABSTRACT FROM AUTHOR]

The authors recommend the adoption of an equity-based approach to achieve child health equity and improve outcomes for children. They offer a comparison of traditional clinical practice guidelines (CPG) development and equity-based approaches to address child health disparities. They explain the implications of using an equity-based approach to CPG development to inform clinical-decision making.