Denver Health Patient Navigator Research Program

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Denver Health Patient Navigator Research Program
Peter Raich, M.D. Principal Investigator Elizabeth
Whitley, Ph.D., R.N. Co-Principal Investigator
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General Framework of Patient Navigator Program
PATIENT NAVIGATION

• Abnormal finding/diagnosis to resolution
• Eliminate critical delivery gap for populations
  experiencing disparities
• Test feasibility of Patient Navigation
  intervention concept
• Identify, test, and measure delivery improvement
  interventions that use Patient Navigators

REHABILITATION
OUTREACH
Resolution
Abnormal Finding
Conclude Navigation
Initial Contact
Abnormal results/ Diagnosis
Diagnosis
Treatment
Survivorship
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Denver Health Improving Patient Outcomes through
System Navigation

• Collaboration between Denver Health, University
  of Colorado at Denver and Health Sciences Center
  Comprehensive Cancer Center, Departments of
  Preventive Medicine Biometrics and Colorado
  Health Outcomes Program

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Proposed Outcomes Aims 1-2 (breast, colorectal
and prostate)

• Aim 1 To reduce the time between abnormal
  screening test to a positive/negative confirmed
  diagnosis
• Aim 2 Reduce the time from a positive diagnosis
  to the start of therapy

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Proposed Outcomes Aims 3, 4 5

• Aim 3 To increase the proportion of patients
  adhering to recommendations for care, including
  completion of additional diagnostic tests,
  consultation appointments and treatment
• Aim 4 To improve patient reported medical
  self-efficacy, satisfaction with care, reduced
  barriers to care, and distress across the entire
  cancer care experience
• Aim 5 To examine the cost-effectiveness of
  patient navigation

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Denver Health Improving Patient Outcomes through
System Navigation

• 4.5 FTE PNs work with Breast, Prostate and
  Colorectal diagnostic and cancer patients
• Pre intervention survey at consent
• Post intervention surveys by UCDHSC Computer
  Assisted Telephone Interview (CATI) unit

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What Do Patient Navigators Do?

• Work with client to identify barriers to care and
  implement strategies to eliminate or reduce these
  barriers

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BREAST CANCER PATIENTS Steps involved from
Diagnosis to Treatment Routine Mammogram ? Diagnos
tic Mammogram/Ultrasound ? Biopsy ? Post-operative
appointment after the Biopsy ? Pre-operative
appointment before Surgery ? Surgery ? Post-operat
ive appointment after Surgery ? Referral to
Medical Breast Clinic ? First visit to the
Medical Breast Clinic ? PreTreatment Tests
? Port placement ? Treatment ? Follow-up visits
with the Medical Oncologist/ Nurse Practitioner
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Examples of Barriers

• Transportation
• Housing
• Language
• Literacy
• Un- or under-insured
• Financial

• Communication with providers
• Fear
• Work schedule conflicts
• Co-morbidities
• Patient Disabilities
• System scheduling issues

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Accrual as of June 24, 2008

• Current Accrual
• Screening patients
• 227 breast
• 46 prostate
• 89 colorectal
• Cancer patients
• 36 breast
• 17 prostate
• 13 colorectal
• Total 429 patients

• Goal by September 2011
• 1,494 screening patients
• 246 cancer patients
• Total 1,740

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Demographics of 340 Enrolled Patients

• 49 Latino
• 19 African American
• 24 Spanish speakers
• 30 Married
• 36 lt High School Education
• 22 Work Full Time
• 41 Household income lt 10,000

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Demographics continued

• 50 own car
• 55 own their home
• 50 have a family history of cancer

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Challenges

• Identification of potentially eligible
  participants
• Evolving standards of care, i.e., colonoscopy
• Proliferation of Patient Navigation Programs
• Defining scope of patient navigator role

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Learn about

• Effect of patient navigator on timeliness
• Characteristics of patient navigator associated
  with patient outcomes
• Activities associated with improved patient
  outcomes?
• Elements of patient navigator training
• How navigators impact satisfaction with medical
  care

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Denver Health Patient Navigator Research Program
Contact information Peter Raich
peter.raich_at_dhha.org Elizabeth Whitley
lwhitley_at_dhha.org Patricia Valverde
patricia.valverde_at_uchsc.edu