The longitudinal impact of patient navigation on equity in colorectal cancer screening in a large primary care network

Abstract

BACKGROUND:The long-term effects of interventions to improve colorectal (CRC) screening in vulnerable populations are uncertain. The authors evaluated the impact of patient navigation (PN) on the equity of CRC prevention over a 5-year period. METHODS: A culturally tailored CRC screening PN program was implemented in 1 community health center (CHC) in 2007. In a primary care network, CRC screening rates from 2006 to 2010 among eligible patients from the CHC with PN were compared with the rates from other practices without PN. Multivariable logistic regression models for repeated measures were used to assess differences over time. RESULTS: Differences in CRC screening rates diminished among patients at the CHC with PN and at other practices between 2006 (49.2% vs 62.5%, respectively; P <.001) and 2010 (69.2% vs 73.6%, respectively; P <.001). The adjusted rate of increase over time was higher at the CHC versus other practices (5% vs 3.4% per year; P <.001). Among Latino patients at the CHC compared with other practices, lower CRC screening rates in 2006 (47.5% vs 52.1%, respectively; P 5.02) were higher by 2010 (73.5% vs 67.3%, respectively; P <.001). Similar CRC screening rates among non-English speakers at the CHC and at other practices in 2006 (44.3% vs 44.7%, respectively; P 5.79) were higher at the CHC by 2010 (70.6% vs 58.6%, respectively; P <.001). Adjusted screening rates increased more over time for Latino and non-English speakers at the CHC compared with other practices (both P <.001). CONCLUSIONS: A PN program increased CRC screening rates in a CHC and improved equity in vulnerable patients. Long-term funding of PN programs has the potential to reduce cancer screening disparities. Cancer 2014;120:2025-31.

Navigating Language Barriers: A Systematic Review of Patient Navigators’ Impact on Cancer Screening for Limited English Proficient Patients

“…25,26 RESULTS Figure 1 presents a PRISMA flow diagram demonstrating the systematic review process and the final 15 articles that were included in the narrative review. The 15 studies were subdivided according to type of cancer screening that was evaluated, including breast (combined with other cancers), [27][28][29][30][31] colorectal cancer, [32][33][34][35][36][37][38][39][40][41][42][43][44] and cervical cancer, [45][46][47] represented in Table 1. Fifteen non-English languages were evaluated in these studies.…”

“…45,46 Seven (46 %) were cohort studies. 27,[29][30][31]39,43,47 . All the navigators in the studies assisted patients in navigating the cancer screening (e.g., setting up appointments and making reminder calls) along with providing language services.…”

“…46 Only one study demonstrated no impact of navigation on breast cancer screening rates for Bengali or Pakistani women. 28 Five of the studies described the level of training received by the patient navigators, 30,31,35,37,43 which ranged from 6-hour trainings 37 to 2-day workshops with an additional follow up training one year later. 42 Two studies described their intervention personnel as Blink workers^who primarily provided interpreting services and education on screening procedures.…”

“…The spoken non-English language skills of the patient navigators were minimally reported in seven, as navigators were described as Bbilingual,^either noted to be originally from a country where the target language was spoken, or the navigator's ethnicity was used as an additional descriptor (i.e., Bbilingual Hispanic woman^). 27,31,35,37,39,41,43 None of the studies formally assessed the language skills of the patient navigators in English or the target language.…”

Building Equity Improvement into Quality Improvement: Reducing Socioeconomic Disparities in Colorectal Cancer Screening as Part of Population Health Management

“…4,5 Previous studies have demonstrated that several approaches for increasing overall CRC screening and reducing disparities in CRC screening are possible, such as mailed interventions, telephone outreach, and patient navigation. [10][11][12][13][14][15][16][17][18][19][20][21] However, it is unclear whether a pragmatic intervention targeting screening in large healthcare delivery systems with diverse practice types can simultaneously achieve these twin aims of quality and equity improvement. Programs targeting population-level screening rates may actually increase disparities if they are more successful in well-off groups, 13 while interventions meant to improve equity may not increase overall screening rates.…”