Assessing the implementation of a patient navigation intervention for colonoscopy screening

• Type of Material: Article
• Authors: Amy DeGroff, Centers for Disease Control and Prevention; Lindsay Gressard, Centers for Disease Control and Prevention; Rebecca Glover-Kudon, Centers for Disease Control and Prevention; Ketra Rice, Centers for Disease Control and Prevention; Felicia Solomon Tharpe, Centers for Disease Control and Prevention; Ngoc-Cam Escoffery, Emory University; Joanne Gersten, Mary Hitchcock Memorial Hospital; Lynn Butterly, Mary Hitchcock Memorial Hospital
• Language: English
• Date: 2019-11-06
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12913-019-4601-4
• Title of Journal or Parent Work: BMC HEALTH SERVICES RESEARCH
• Volume: 19
• Issue: 1
• Start Page: 803
• End Page: 803
• Grant/Funding Information: None to report.
• Keywords: Patient navigation; CHALLENGES; Public health; Colonoscopy; PROGRAM; PREFERENCES; Life Sciences & Biomedicine; CANCER; Cancer screening; DISPARITIES; Health Care Sciences & Services; Science & Technology; Disparate populations; DIVERSE; UNITED-STATES
• Research Categories: Health Sciences, Public Health; Health Sciences, Oncology

Abstract

Background: A recent study demonstrated the effectiveness of the New Hampshire Colorectal Cancer Screening Program's (NHCRCSP) patient navigation (PN) program. The PN intervention was delivered by telephone with navigators following a rigorous, six-topic protocol to support low-income patients to complete colonoscopy screening. We applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework to examine implementation processes and consider potential scalability of this intervention. Methods: A mixed-methods evaluation study was conducted including 1) a quasi-experimental, retrospective, comparison group study examining program effectiveness, 2) secondary analysis of NHCRCSP program data, and 3) a case study. Data for all navigated patients scheduled and notified of their colonoscopy test date between July 1, 2012 and September 30, 2013 (N = 443) were analyzed. Researchers were provided in-depth call details for 50 patients randomly selected from the group of 443. The case study included review of program documents, observations of navigators, and interviews with 27 individuals including staff, patients, and other stakeholders. Results: Program reach was state-wide, with navigators serving patients from across the state. The program successfully recruited patients from the intended priority population who met the established age, income, and insurance eligibility guidelines. Analysis of the 443 NHCRCSP patients navigated during the study period demonstrated effectiveness with 97.3% completing colonoscopy, zero missed appointments (no-shows), and 0.7% late cancellations. Trained and supervised nurse navigators spent an average of 124.3 min delivering the six-topic PN protocol to patients. Navigators benefited from a real-time data system that allowed for patient tracking, communication across team members, and documentation of service delivery. Evaluators identified several factors supporting program maintenance including consistent funding support from CDC, a strong program infrastructure, and partnerships. Conclusions: Factors supporting implementation included funding for colonoscopies, use of registered nurses, a clinical champion, strong partnerships with primary care and endoscopy sites, fidelity to the PN protocol, significant intervention dose, and a real-time data system. Further study is needed to assess scalability to other locations.