Dissemination of Patient Navigation Programs Across the United States

Hedlund, Nancy; Risendal, Betsy; Pauls, Heather; Valverde, Patricia; Whitley, Elizabeth M.; Espàrza, Angelina; Stiehl, Emily; Calhoun, Elizabeth A.

doi:10.1097/phh.0b013e3182a505ec

Cited by 38 publications

(41 citation statements)

References 20 publications

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“…8,9 Further, informal connections between different hospitals, such as collaboration between providers or the emergence of patient navigators and care managers, may mitigate the mechanisms through which two-hospital care potentially impacts patient outcomes. 28,29 …”

Section: Discussionmentioning

confidence: 99%

Fragmentation in specialist care and stage III colon cancer

Hussain

Chang

Veenstra

et al. 2015

Cancer

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Background Patients with cancer frequently transition between different types of specialists and across care settings. We explored how frequently the medical and surgical oncologic care of stage III colon cancer patients occurs across more than one hospital and whether this is associated with mortality and costs. Methods This is a retrospective SEER-Medicare cohort study of 9,075 stage III colon cancer patients diagnosed between 2000 and 2009 receiving both surgical and medical oncologic care within one year of diagnosis. Patients were assigned to the hospital where they had their cancer surgery and to their oncologist's primary hospital, and then characterized according to whether these hospitals were same or different. Outcomes included all-cause mortality, subhazards for colon cancer specific mortality, and cost of care at 12 months. Results 37% of patients received their surgical and medical oncologic care from different hospitals. Rural patients were less likely than urban patients to receive medical oncologic care from the same hospital (OR 0.62, 95%CI 0.43-0.90). Care from the same hospital was not associated with reduced all-cause or colon cancer specific mortality but resulted in lower costs at 12 months (dollars saved $5493, 95%CI $1799, $9525), 8% of median cost. Conclusions Delivery of surgical and medical oncology care at the same hospital was associated with lower costs; however, reforms which seek to improve outcomes and cost through integrating complex care will need to address the significant proportion of patients receiving care across more than one hospital.

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Section: Discussionmentioning

confidence: 99%

Fragmentation in specialist care and stage III colon cancer

Hussain

Chang

Veenstra

et al. 2015

Cancer

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“…21 There are a growing number of lay navigation programs using non-nurse community members (specialized community health workers) to provide these services to patients, particularly in underserved communities. 22 Navigator programs have shown benefits in reducing disparities in access to care for prevention, early detection, and early treatment of cancer, 23–27 and improving patient experience. 14,28,29 Despite mounting evidence of the benefits of navigation and the emergence of navigator-training programs with recommended competencies, 30–32 the process of navigation is yet to be standardized and tools to guide daily operations are lacking.…”

Section: Introductionmentioning

confidence: 99%

Guiding Lay Navigation in Geriatric Patients With Cancer Using a Distress Assessment Tool

Rocque

Taylor

et al. 2016

J Natl Compr Canc Netw

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Background: There is growing interest in psychosocial care and evaluating distress in cancer patients. As of 2015, the Commission on Cancer requires cancer centers to screen patients for distress, but the optimal approach to implementation remains unclear. Methods: We assessed feasibility and impact of using distress assessments to frame lay navigator-patient interactions in geriatric cancer patients that were enrolled in navigation between 1/1/2014 and 12/31/2014. Results: Of the 5121 patients enrolled in our lay patient navigation program, 4,520 (88%) completed at least one assessment using a standardized distress tool (DT). Navigators used the tool to structure both “formal” and “informal” distress assessments. Twenty-four percent of patients reported distress scores ≥4 and 5.5% reported distress scores ≥8. The most common sources of distress at initial assessment were pain, balance/mobility difficulties, and fatigue. Minority patients reported similar sources of distress as the overall program population, with increased relative distress related to logistical issues such as transportation and financial/insurance questions. Patients were more likely to ask for help with questions about insurance/financial needs (79%), transportation (76%) and knowledge deficits about diet/nutrition (76%) and diagnosis (66%) when these items contributed to distress. Conclusions: Lay navigators were able to routinely screen for patient distress at a high degree of penetration using a structured distress assessment.

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“…4 Many early patient navi-programs have used non-nurse community members to provide these services to patients, particularly in underserved communities. 5 The use of lay, or nonclinical, personnel allows for a low-cost expansion of the work force available to support patients with cancer. Navigation programs have demonstrated reductions in cancer screening disparities, increased appointment adherence, improved clinical trial retention, and have resulted in improved patient satisfaction.…”

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confidence: 99%

The Patient Care Connect Program: Transforming Health Care Through Lay Navigation

Rocque

Partridge

Pisu

et al. 2016

JOP

106

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The Patient Care Connect Program (PCCP) is a lay patient navigation program, implemented by the University of Alabama at Birmingham Health System Cancer Community Network. The PCCP’s goal is to provide better health and health care, as well as to lower overall expenditures. The program focuses on enhancing the health of patients, with emphasis on patient empowerment and promoting proactive participation in health care. Navigator training emphasizes palliative care principles and includes development of skills to facilitate advance care planning conversations. Lay navigators are integrated into the health care team, with the support of a nurse supervisor, physician medical director, and administrative champion. The intervention focuses on patients with high needs to reach those with the greatest potential for benefit from supportive services. Navigator activities are guided by frequent distress assessments, which help to identify patient concerns across multiple domains, triage patients to appropriate resources, and ultimately overcome barriers to health care. In this article, we describe the PCCP’s development, infrastructure, selection and training of lay navigators, and program operations.

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Dissemination of Patient Navigation Programs Across the United States

Cited by 38 publications

References 20 publications

Fragmentation in specialist care and stage III colon cancer

Fragmentation in specialist care and stage III colon cancer

Guiding Lay Navigation in Geriatric Patients With Cancer Using a Distress Assessment Tool

The Patient Care Connect Program: Transforming Health Care Through Lay Navigation

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