Economic assessment of patient navigation to colonoscopy‐based colorectal cancer screening in the real‐world setting at the University of Chicago Medical Center

Abstract

BACKGROUND: This report details the cost effectiveness of a non-nurse patient navigation (PN) program that was implemented at the University of Chicago Medical Center to increase colonoscopy-based colorectal cancer (CRC) screening. METHODS: The authors investigated the impact of the PN intervention by collecting process measures. Individuals who received navigation were compared with a historic cohort of non-navigated patients. In addition, a previously validated data-collection instrument was tailored and used to collect all costs related to developing, implementing, and administering the program; and the incremental cost per patient successfully navigated (the cost of the intervention divided by the change in the number who complete screening) was calculated. RESULTS: The screening colonoscopy completion rate was 85.1% among those who were selected to receive PN compared with 74.3% when no navigation was implemented. With navigation, the proportion of no-shows was 8.2% compared with 15.4% of a historic cohort of non-navigated patients. Because the perceived risk of noncompletion was greater among those who received PN (previous no-show or cancellation, poor bowel preparation) than that in the historic cohort, a scenario analysis was performed. Assuming no-show rates between 0% and 50% and using a navigated rate of 85%, the total incremental program cost per patient successfully navigated ranged from $148 to $359, whereas the incremental intervention-only implementation cost ranged from $88 to $215. CONCLUSIONS: The current findings indicate that non-nurse PN can increase colonoscopy completion, and this can be achieved at a minimal incremental cost for an insured population at an urban academic medical center.

A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program

“…For example, for an intervention using mailed FIT kits (reduction of structural barriers by eliminating a visit to the clinic), we calculated the proportion of FIT kits returned and estimated the cost per kit returned to assess the sustainability of the intervention. To evaluate another intervention on patient navigation, we determined the proportion of individuals who successfully received patient navigation and used a historic cohort to quantify its effectiveness . Although, in several instances, we identified adequate control cohorts to perform comparative assessments, including the use of randomization, for some of the evaluations, the study design only allowed for pre‐post assessments .…”

“…18 To evaluate another intervention on patient navigation, we determined the proportion of individuals who successfully received patient navigation and used a historic cohort to quantify its effectiveness. 19 Although, in several instances, we identified adequate control cohorts to perform comparative assessments, including the use of randomization, for some of the evaluations, the study design only allowed for pre-post assessments. 20,21 In these instances, we report not only screening rates but also process measures to ensure that we capture the underlying activities and procedures that were affected by the interventions so lessons learned can be shared.…”

Identifying optimal approaches to implement colorectal cancer screening through participation in a learning laboratory

“…In this effort, the CDC works intensively with 4 or 5 awardee programs for a specified period of time to complete multiple studies and then transitions to support a new group of programs participating in the learning laboratory. The current series presents findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments . Table provides an overview of these awardees.…”

“…The current series presents findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments. [10][11][12][13][14] Table 1 provides an overview of these awardees.The results presented by the Washington State Department of Health and the Colorado Department of Public Health and Environment provide valuable evidence that EBIs implemented in real-world settings can increase CRC screening, even among the diverse, low-income populations seeking health care at FQHCs. In Washington State, the mailed fecal immunochemical test (FIT) program had a test return rate of 31% with an average intervention cost of $18.76 per FIT kit returned (this does not include the cost of purchasing the kit or processing returned kits).…”

“…The current series presents findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments. [10][11][12][13][14] Table 1 provides an overview of these awardees.…”