背景:患者导航是一种基于证据的干预措施,通过直接解决对服务不足的癌症患者的护理障碍来减少癌症健康差异。癌症护理环境中患者导航计划的设计和整合的变化限制了这种干预的效用。实施科学评估框架,重新瞄准,允许对癌症护理环境中患者导航计划的有效实施进行定量和定性检查。
方法:TheReach,有效性,收养,实施,和维护(RE-AIM)框架用于评估2018年6月至2021年10月在NCI指定的癌症中心实施以社区为中心的患者导航干预措施.使用3个月的纵向,非比较测量期,进行了单变量和双变量分析,以检查参与者水平的人口统计学和主要(即,屏障减少)和次要(即,患者报告的结果)有效性结果。使用混合方法分析来检查癌症中心环境中干预措施的采用和交付。使用过程级分析来评估干预措施的维持情况。
结果:参与者(n=311)代表了大部分服务不足的人群,根据国家癌症研究所的定义,大多数人认为是西班牙裔/拉丁裔,家庭收入在35000元或以下,并被纳入医疗补助计划。参与者被诊断出患有多种癌症类型,大多数患有晚期癌症。干预前、干预后分析显示,干预前评估报告的障碍平均数显著减少,F(1,207)=117.62,p<.001,以及患者报告的身体健康显着增加,t(205)=-6.004,p<.001,心理健康,t(205)=-3.810,p<.001,自我效能感,t(205)=-5.321,p<.001,以及对医疗团队沟通的满意度,t(206)=-2.03,p=0.029。转诊模式和定性数据支持更多地采用干预措施并将其纳入目标设定,和一致的干预交付指标表明,随着时间的推移,干预交付具有很高的保真度。过程级数据概述了从赠款资助的以社区为中心的患者导航干预到机构资助的计划的成功过渡。
结论:这项研究利用了实施科学评估框架,重新瞄准,评估以社区为中心的患者导航计划的实施情况。我们的分析表明在癌症护理环境中成功实施,并为可能对实施以社区为中心的患者导航计划感兴趣的其他肿瘤学环境提供了潜在的指导。
BACKGROUND: Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention\'s utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings.
METHODS: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention.
RESULTS: Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = - 6.004, p < .001, mental health, t(205) = - 3.810, p < .001, self-efficacy, t(205) = - 5.321, p < .001, and satisfaction with medical team communication, t(206) = - 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program.
CONCLUSIONS: This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.