Building a Navigation Program

Although Hispanic men are at higher risk of developing colon cancer compared to non-Hispanic white men, colonoscopy screening among Hispanic men is much lower than among non-Hispanic white men. University Health System (UHS) in San Antonio, Texas, instituted a Colorectal Cancer Male Navigation (CCMN) Program in 2011 specifically designed for Hispanic men. The CCMN Program contacted 461 Hispanic men 50 years of age and older to participate over a 2-year period. Of these age-eligible men, 370 were screened for CRC after being contacted by the navigator. Using participant and program data, a Markov model was constructed to determine the cost-effectiveness of the CCMN Program. An average 50-year-old Hispanic male who participates in the CCMN Program will have 0.3 more quality-adjusted life-years (QALYs) compared to a similar male receiving usual care. Life expectancy is also predicted to increase by 6 months for participants compared to non-participants. The program results in net health care savings of $1,148 per participant ($424,760 for the 370 CCMN Program participants). The incremental cost-effectiveness ratio is estimated at $3,765 per QALY in favor of the navigation program. Interventions to reduce disparities in CRC screening across ethnic groups are needed, and this is one of the first studies to evaluate the economic benefit of a patient navigator program specifically designed for an urban population of Hispanic men. A colorectal cancer screening intervention which relies on patient navigators trained to address the unique needs of the targeted population (language barriers, transportation and scheduling assistance, colon cancer, and screening knowledge) can substantially increase the likelihood of screening and improve quality of life in a cost-effective manner.

Tackling complex problems within communities requires collaborative actions and interventions. This study examines the collaborative actions of a United States (U.S.), Texas community to develop a new community-based initiative. Using the Collective Impact approach to address gaps in services for veterans, a navigator model provided a culturally sensitive method for addressing veteran mental health and related needs. The objective of this qualitative, case-study research was to explore the potential replication of a Veteran Community Navigator (VCN) program by examining the development and implementation of program processes within the community. Data were collected through interviews and focus groups with 14 participants, content analysis of 25 records, and field notes of veteran work groups and veteran housing meetings. Relevant findings indicated factors critical to program success and replication included collaboration and outreach, developing program processes from the ground up, military and community cultural knowledge among program staff, and the integration of agency services with other community social services. Future research should focus on comparative studies examining differences between veteran-serving navigator programs that utilize clinical staff and those that do not, military cohorts that are more likely to access and use navigator services, and factors that predict long-term sustainability of veteran navigator programs.

IA35: Sustainabity of patient navigation programs: Lessons learned from a Medicare innovation project

Cancer Patient Navigation in Canada: Directions From the North

<strong>Background:</strong> Breast cancer screening programmes have been developed in few developing countries to aid curb the increasing burden. However, breast cancer is still being detected in late stage, attributed to barriers in health care. Patient navigation programmes have been implemented in developed countries to help patients overcome these barriers, and they have been associated with early detection and timely diagnosis. Despite the consistent positive effects of breast navigation programmes, there are no studies conducted to show its effect in Africa where the needs are enormous.<br /><strong>Aim:</strong> To evaluate the effect of patient navigation programme on patient return after an abnormal clinical breast cancer screening examination finding at Aga Khan University Hospital, Nairobi(AKUH-N).<br /><strong>Setting:</strong> Women presenting for breast screening.<br /><strong>Methods:</strong> This was a before-and-after study conducted on 76 patients before and after the implementation of the navigation programme. They were followed up for 30 days. Measures included proportion of patient return and time to return.<br /><strong>Results:</strong> The proportion of return of patients in the navigated and non-navigated group was 57.9% and 23.7%, respectively (odds ratio [OR]: 4.43 [95% confidence interval, CI: 1.54– 12.78]; <em>p</em> = 0.0026).The proportion of timely return in the navigated group was 90.1% and 77.8% for the non-navigated group (OR: 2.85 [95% CI: 0.34–24.30], <em>p</em> = 0.34). The mean time to return in the non-navigated and navigated group was 7.33 days and 8.33 days, respectively (<em>p</em> = 0.67).<br /><strong>Conclusion:</strong> There was an increase in the proportion of patients who returned for follow-up following abnormal clinical breast examination finding after implementation of the breast navigation programme at AKUH-N.

On April 9, 2013, the Centers for Medicare and Medicaid Services of the Department of Health and Human Services announced the availability of $54 million to fund navigator programs in states that have federally facilitated or partnership exchanges. This funding is not available for states that operate their own exchanges, which must pay for their own navigator programs. Since federal establishment grants cannot be used to fund state navigator programs, it is possible that some states with state exchanges will not have navigator programs up and running until after their exchanges open and begin to generate their own revenue. It is hoped, however, that the gap in these states will be filled by consumer in-person assisters, who can be paid from establishment grants and should become available this year. Each state will qualify for at least $600,000 in funds, with states with larger uninsured populations qualifying for larger amounts. Texas, for example, will qualify for $8,181.185 in grants; Florida for $5,851,072. Thirteen states will qualify for the minimum $600,000. (Curiously, the list of federal exchanges includes Utah, which earlier received contingent approval to establish a state exchange). If all the funds allocated to any state are not awarded within that state, any remaining funds will be awarded to grant applicants from other states based on their meeting the funding criteria. Applications are due June 7, 2013, and awards will be made on August 15, 2013. Funds will be provided through cooperative agreements rather than grants, the distinction turning on the greater federal programmatic involvement under cooperative agreements.

Introduction: Vaccination has led to significant decreases in mortality over the last century but requires high levels of uptake to be successful in reducing a wide range of infectious diseases in communities. Vaccine hesitancy is on the rise in the United States with most adults not receiving all recommended vaccinations, and childhood vaccinations are declining. Living in a rural community with a lack of access to resources may further limit uptake of vaccines. Identifying strategies to enhance vaccine confidence and access may assist in increasing vaccine uptake. The purpose of this study was to describe the landscape of existing community-based vaccination efforts and assess the components of a successful community-based vaccination program in rural eastern North Carolina. To reach this purpose, we conducted qualitative interviews with those involved in running community-based vaccine education and navigation programming in rural eastern North Carolina.” Methods: Researchers conducted 25 semi-structured interviews with participants involved in vaccination efforts in three rural counties in Eastern North Carolina. Interviews were transcribed, coded in NVivo version 14, and analyzed using thematic analysis to synthesize insights from participants. Results: Study participants held manager or coordinator roles in area health agencies, clinics, and pharmacies. Reported strengths of current vaccine efforts in Eastern North Carolina included patient education, strong partnerships between organizations providing vaccines, and ability to engage community members. Successful vaccine efforts have engaged participants through social media, flyers, trusted leaders, and the provision of convenient vaccine appointments. Areas for improvement in vaccine efforts included engaging a wider audience at vaccine events, building trust in vaccines among community members, and expanding vaccine education for hard-to-reach populations. Participants supported the development of a proposed community-based education and navigation program and felt that community members would be interested. Identified challenges included low participation due to vaccine hesitancy which could be overcome through incentives and delivery from trusted individuals. Conclusions: We found that there is still a need for trust building, education, and patient engagement within the landscape of existing community-based vaccination efforts for vulnerable populations in rural eastern North Carolina. Study participants indicated support for the development of a vaccine education program and researchers determined the project to be feasible. Based on the results of this study, researchers developed and implemented an integrated vaccine education and navigation program in Eastern North Carolina.

e13532 Background: Navigation in oncology has demonstrated benefits for people at risk for or diagnosed with cancer. These include a shorter time to diagnosis and start of treatment, better adherence to recommended care, and improved quality of life. Implementing a nurse navigation program can be challenging in developing countries, especially when involving nationwide health care networks. This study describes the implementation of a pioneering oncology navigation program in Brazil. Methods: Rede D’Or São Luiz (RDSL) is Brazil's largest integrated private health care network, comprising 63 general tertiary hospitals and 50 oncology clinics in 13 states. In 2018 a comprehensive oncology navigation program was started. The first phase focused on identifying suspected or diagnosed cancer patients who attended general hospitals to improve their care coordination. A trained nurse was allocated to support each hospital, supervised by a regional nurse coordinator and physician. A web-based system was created, by the participants, to integrate data collected from all hospitals. Epidemiological, social, and clinical data were obtained, including time to establish a cancer diagnosis and start of treatment. A national virtual meeting is held every two weeks to present anonymous data, compare results, and create solutions to address national and local barriers. Results: From 2018 to 2022, a total of 25,862 potential patients were identified by the navigation program. Of these, 10,951 ended with a diagnosis of cancer. Currently 32 hospitals from 6 different cities are involved. In the beginning, most patients (38%) were identified at Inpatient Clinical Units, after a cancer diagnosis. Over time the number of patients identified at surgical and diagnostic centers increased from 365 to 589 and 282 to 542, respectively. Cancer epidemiology was comparable to Brazilian data. Most patients had breast cancer (13%), followed by prostate cancer (12%) and colon cancer (7%). These numbers were slightly different according to hospital location. The number of patients recruited at Emergency rooms is still low (9%) comparable to other facilities. A total of 2,391 patients required an inpatient treatment approach, supported by the oncology team. Conclusions: The goal of the navigation program is to reduce cancer morbidity and mortality by eliminating barriers to timely access to cancer care, which may be financial, social, logistical, or related to communication and equity of health care delivery. These results show that RDSL National Oncology Navigation Program is feasible. After this implementation phase, a comprehensive database was built to guide care coordination, and there was a shift to earlier identification of potential patients. In the future, we expect that data collected from this project may help individual patients and families but also address cancer care disparities over the country.

System navigation programs are becoming more available to meet the needs of patients with complex care needs. The aim of this review was to systematically assess the outcomes of navigation programs for persons with dementia and their family caregivers. A systematic review methodology was employed. Ten databases were searched for all relevant articles published until October 30, 2021. English-language full-text articles were included if they focused on implemented navigation program(s) that primarily supported persons with dementia who were aged 50 or older. Methodological quality was assessed by 2 independent raters using the Physiotherapy Evidence Database Scale, the STrengthening the Reporting of OBservational studies in Epidemiology checklist, and the Mixed Methods Appraisal Tool. Fourteen articles were included in the review. There was Level 1 evidence for the benefits of system navigation programs on delaying institutionalization, wherein benefits appeared to be specific to interventions that had an in-person component. There was Level 1 (n = 4) and Level 3 (n = 1) evidence on service use from time of diagnosis to continued management of dementia. Finally, Level 1 to Level 5 evidence indicated a number of benefits on caregiver outcomes. There is strong evidence on the benefits of system navigation for people with dementia on delaying institutionalization and caregiver outcomes, but outcomes across other domains (i.e., functional independence) are less clear, which may be due to the varied approaches within system navigation models of care.

6555 Background: Lung cancer (LC) is the leading cause of cancer death in the US in both men and women; causing 25% of all cancer deaths. Annual lung cancer screening (LCS) with a low-dose CT (LDCT) in high-risk individuals (aged 50-80 with a >20 pack-year smoking history) decreases LC deaths by 20% and is recommended by USPSTF. Despite the efficacy, uptake of LDCT remains low at 6% nationally, and 13% in Rhode Island. Patient (pt) and provider perceived barriers, along with racial, ethnic and socioeconomic disparities widen the gap. We evaluated the implementation of a LCS navigation program at an urban community health center (CHC) with a multiethnic, socioeconomically underserved population. Methods: A bilingual (English and Spanish speaking) pt navigator was integrated into routine clinic practice at a large primary care CHC group, across 4 sites, starting in January 2022. The navigator’s role was to assess pt and provider awareness of the LCS process, assess for systemic barriers, and provide navigational support for the LDCT process. Pts eligible for LCS at the CHC from 1/2022 to 12/2022 were retrospective examined; 50 to 80 years and a >20 pack-year smoking history. The navigator administered a questionnaire to assess barriers to LDCT and demographic variables. Results: A total of 360 eligible pts were seen across the CHC practice in 2022, of which 149 (41.4%) agreed to undergo LDCT after counseling and shared decision making and 28% of these (n 101) completed LDCTs. 153 of the eligible pts completed the survey questionnaire. Of these, 50% were females; 40% were Hispanic/Latinx, 40% were non-Hispanic/Latinx and 22% declined to answer. Majority, 61% were white, 10% African American/Black and 28% declined to answer. A sizeable proportion were non-English speaking (34%) and resided in cities with Rhode Island’s lowest per-capita incomes (Pawtucket 48%), Central Falls (32%) and North Providence/Providence (10%). In assessing barriers to LCS, 46% of pts were not aware of the LCS process and 44% were unaware that LCS was covered by health insurance; 58% of eligible pts did not recall their PCP discussing LCS. Of the LDCTs resulted available at the time of analysis, 84% were Lung RADS-1 and 16% Lung RADS-4 category. Conclusions: Our study highlights the unique barriers to LCS in an urban multiethnic community. While access to LCS remains an issue, pt awareness of the lung cancer screening process was the major barrier. A patient navigation program is critical to the success of LCS in a community, by providing education to patients and providers and the necessary logistical support needed in the LDCT process. With a community based navigational program, we demonstrate a significant increase in lung cancer screening rates in our population to 28% as compared to the state LCS rate of 13%. (Supported by the Robert A. Winn Diversity in Clinical Trials Career Development Award).

To increase colorectal cancer screening among urban minorities, New York Presbyterian Hospital/Columbia University, with support from the New York City Department of Health and the Citywide Colon Cancer Control Coalition (C5), instituted a patient navigation and direct endoscopic referral system. We assessed the effect of this program on the volume of colonoscopy in this institution, which caters to a socioeconomically diverse patient population. We compared colonoscopy volume during the first year of the navigator program with the volume during the year before this program. We stratified on Medicaid status to assess the secular trend of screening rates. To assess quality during this period, we measured cecal intubation rates, preparation quality, and adenoma detection rates. Of the 749 patients assessed by the patient navigators, 678 (91%) underwent colonoscopy. Colonoscopy volume among the Medicaid outpatients increased by 56% (957 to 1489). Adenoma detection was 27% and the cecal intubation rate was 97%. Comparing navigated patients with the nonnavigated Medicaid outpatients, preparation quality was superior (34% vs. 40% suboptimal, P=0.0282), although preparation quality remained inferior to that of private patients (20% suboptimal, P<0.0001). Volume of the colonoscopy increased, coinciding with the onset of the patient navigation program. This increase was nearly entirely owing to a rise in the colonoscopies among Medicaid outpatients, the principal focus of the navigator program. This increase in quantity was accomplished while maintaining an overall high level of quality as measured by cecal intubation rates and adenoma detection, although preparation quality requires further efforts at improvement.

Background: This study aimed to evaluate the effects of a nurse-led navigation program for gastric cancerpatients with gastrectomy.Method: The experimental group consisted of 23 patients and the control group consisted of 22 patientswithgastric cancer after gastrectomy in K university hospital in Korea.A quasi-experimental study with anonequivalent control group was used. This study consists of two phases: a methodological study to developa navigation program for gastric cancer patients and a quasi-experimental study to verify the effects of thenavigation program. The navigation program was administered to the experimental group over 3 monthswith a total of 8 sessions.Result:The experimental group had lower distress than the control group (F = 5.298, p = 0.004).Theexperimental group had less weight changes than the control group (F = 4.390, p = 0.019), and thehealthcare service satisfaction with regard to nurses was high (Z = 2.932, p = 0.003). However, the qualityof life was not significantly different(F = 5.905, p = 0.707).Conclusion: The nurse-led navigation program for gastric cancer patients was effective at reducing distress,improving nutritional status, and increasing satisfaction with healthcare services. It is suggested to conductlong-term follow-up research to measure quality of life changes from the navigation program.

PurposeAfrican American/Black men are disproportionately impacted by prostate cancer (PCa). Patient navigation is an evidence-based approach to address barriers to care, improve access to care and health outcomes, and reduce disparities. This scoping review provides an in-depth examination of navigation programs in PCa care across the cancer continuum, with a focus on African American/Black men in the United States.MethodsWe conducted a comprehensive literature search through September 1st, 2023, in PubMed, Embase, Web of Science, and CINAHL Complete, using keywords and index terms within three main themes: PCa, patient navigation, and African American/Black men. We included studies that described or investigated navigation programs/interventions for PCa from screening through survivorship and included at least 30% African American/Black men.ResultsOf the 3,556 articles identified, 8 were included. Two articles covered the same navigation program—one reported the protocol and one reported quasi-experimental trial results. All but one study was conducted prior to 2012. The most common navigation activities reported were care coordination, education/information provision, and comfort/emotional support. Navigation improved screening uptake, PCa management, and access to supportive services. Only 3 articles provided information on navigation training. Both clinical (e.g., nurses) and non-clinical (e.g., peers) navigators were reported. Only 1 article discussed cultural tailoring to African American/Black men.ConclusionNavigation programs in PCa care are beneficial; however, few studies were identified despite disease burden and disparities among African American/Black men. Contemporary navigation programs tailored for African American/Black men are needed to address persistent disparities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-025-10009-7.

Objective:To identify key elements of an outreach strategy for a youth contraception navigator program designed to help young people overcome barriers to contraception access.Methods:A human-centered design approach was used to engage adolescents aged 15–17 in co-design sessions. Human-centered design techniques, such as affinity diagramming and model building were used to inform key elements of the communication model and the final outreach strategy messages.Results:Messages focused on the individual, normalizing talking about birth control, acknowledging the challenges to obtaining birth control, explaining how the navigator program works resonate with young people. Having images of diverse participants, offering information about birth control, and showing images of reputable sources will enhance trust.Conclusions:A name (IN Control) and key elements of an outreach strategy were determined for the navigator program. It is important to work with key stakeholders and co-design the optimal strategy and messages to assure that the intended audience is reached, and the desired behavior change is achieved.Innovation:Human-centered design techniques can be used to provide insight into programmatic outreach strategies for a contraception navigator program to increase their impact and ultimate success.

Engagement in a Social Needs Navigation Program and Health Care Utilization in Pediatric Primary Care.