Ohio Patient Navigator Research Program (OPNRP)

Electra D. Paskett, Ph.D.

April 2007

To develop and evaluate a program to facilitate timely access to quality, standard cancer care for persons diagnosed with breast, cervical, and colorectal cancer in a culturally sensitive manner.

Goal

There is a critical disconnect between cancer discoveries and cancer care delivery to

all American people.

Discovery Development Delivery

Critical Disconnect

Patient Navigator Background

Beneficial procedures for cancer prevention, early detection, diagnosis, and treatment

For All Americans

results in cancer health disparities

Cancer Care Barriers

OUTREACH

PATIENT NAVIGATION

REHABILITATION

General Framework of Patient Navigation Program

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• 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

Abnormal results/ Diagnosis

Diagnosis Treatment Survivorship

Navigator Role

3

Patient Navigator Possible Roles

Cancer Sites To Be ExaminedBreast Cervical Colorectal Prostate

Northwestern—Chicago

UT—San Antonio

University of Rochester

Boston University

Northwest Indian Health

Ohio State (ACS funded)

GWU—Washington, DC

Denver HHA

Moffitt—Tampa

Target Populations

Black Hispanic AI/AN Underserved

Northwestern—Chicago    

UT—San Antonio      

University of Rochester      

Boston University      

Northwest Indian Health      

Ohio State (ACS funded)      

GWU—Washington, DC  

Denver HHA  

Moffitt—Tampa  

•Total population: 711,470• Racial composition: 68% White 25% African American 3% Asian <1% Native American <1% Pacific Islander 3% Two or more races• Hispanic or Latino of any race: 3%• 2003 poverty rate: 16.5%

Columbus, Ohio

OhioState Ranking

Estimated New Cancer: 2004

All Cases 7th

Breast 6th

Cervical 10th Colorectal 6th

American Cancer Society, 2004

OhioState Ranking

Estimated Cancer Mortality: 2004

All Sites 7th

Breast 6th

Colorectal 6th

American Cancer Society, 2004

Theoretical Framework

Patient And Clinic Level Theories

Patient - Social Support/Network - Health Belief Model

Clinic - Innovation and Organizational Change - Physician and Organizational Readiness For Change

• Develop Community Advisory Board

• Select Clinic Sites

• Hire and Train Staff

Specific Aim 1

• Organize community advisory board • Clinical site selection• Staff hired and trained

Start-up Activities

Staff

• Program Manager

• 3 Research Interviewers

• 3 Patient Navigators

Patient Navigator Training• National Training• Local ACS networking, attended meetings, participated

in conference calls and one on one interaction with navigators

• Toured local clinics and hospitals to identify contact people and resources

• Meeting with clinical psychologists and health educators• Ongoing training and weekly meetings w/ Melissa• Attended relevant seminars• Systematically researched and reviewed existing patient

educational materials• Visits to chemo suites, observed procedures• Designed doctor – patient communication handbook

Develop the OPNRP through the work of a consortium of institutions including:

•The Ohio State University Comprehensive Cancer Center and James Cancer Hospital

•Columbus Neighborhood Health Centers

•The Ohio Division of the American Cancer Society

•The Ohio Commission on Minority Health

Specific Aim 2

Community Advisory Board

Diversity Enhancement ProgramHolland

Ohio Commission on Minority HealthBoyce

MEMBERS

Ohio Patient Navigator Research Program

The Ohio State University

OSUCCCPaskett – Principal Investigator

Family Medicine Post – Co Principal Investigator

OSU Primary Care Network

Family MedicineWelker – Collaborator

General Internal MedicineThomas - Co Investigator

Columbus Neighborhood Health Centers

Van Putten - Collaborator

ADMINISTRATIVE CORE

Tatum - Project DirectorDeGraffinreid - Data & QA Supervisor

Cluxton – Program ManagerHennigan – Research Associate

Ball – Database Manager

EVALUATION / RESEARCH COREMurray - LeaderPirie - Process

Caswell - EconomicMcAlearney - Clinic Level

Katz – Health LiteracyKelly – Patient DirectedAlfano – Quality of Life

ExpertsOSUCCC

Breast: ShapiroCervical: O’MalleyColorectal: Saab

PATIENT NAVIGATORS

Katz – Co Investigator Hicks – Navigator Supervisor

Broadnax - Patient NavigatorTeba - Patient NavigatorSilva - Patient Navigator

• Implement and evaluate the OPNRP in 12 primary care clinics using a group randomized, controlled design

Specific Aims 3-5

• Conduct a process evaluation to assess the barriers to implementation, patient satisfaction, clinic perceptions of the OPNRP

• Conduct a cost-effectiveness evaluation of OPNRP

OSU Primary Care Network

Family Medicine (8)- 17,115 patients 51+ years

- 66% female- 31% minority

General Internal Medicine (3)- 6,991 patients 51+ years- 66% female- 11% minority

Neighborhood Health Centers (5)- 2,400 patients 55+ years- 63% females- 53% minority

Study Design

Patient Navigation

Education Only

Participating Clinics

All Populations

2 Intervention & 2 Control

Minority/ Underserved

2 Intervention & 2 Control

Federally Funded

2 Intervention & 2 Control

Clinic Type

Patients Abnormal Cancer Participation

Pap Smears 15,840 3.0% 31.0% 80%

Within 4 Yrs of Study 1,236 384 300

Mammography 10,391 14.0% 15.0% 80%

Within 4 Yrs of Study 2,556 384 300

FS/Colonoscopy 26,232 56.6% 15.6% 80%

Within 4 Yrs of Study 4,920 768 600

Estimated Patients Enrolled

Participating clinic sites

OSU Primary Care Network - 8• OSU Family Practice at Worthington• OSU Family Practice at Gahanna• OSU Family Practice at University Hospital – East• OSU Family Practice on South High• OSU Family Practice at Upper Arlington• Rardin Family Practice• OSU Internal Medicine at Stoneridge• OSU Internal Medicine at University Hospitals – Cramblett

Columbus Neighborhood Health Centers - 4• Hilltop Health Center• John Maloney South Side Health Center• St. Stephen’s Health Center• East Central Health Center

Assess the effect of the OPNRP on reducing time from a patient’s abnormal screening result to:

- Diagnosis/Resolution - Start of treatment

- Completion of treatment

EvaluationPrimary Outcome

• What is working well and not so well?

• Who does not use the navigators, who uses and continues to use navigators and why and what types of activities does the navigator perform?

• What features of the OPNRP are viewed as most positive or helpful by patients, staff, and healthcare providers?

• Does OPNRP succeed in changing intermediate outcomes such as patient knowledge about key resources, feeling of being supported etc?

EvaluationProcess

• Baseline Assessment: Organizational history and current practices

• Follow-up Assessment: How was the patient navigation program received, implemented, and accepted within each clinic

EvaluationClinics

• Program: operational, specific components

• Savings: change in cost attributable to the program

• Effectiveness: cost of the intervention and calculation of net cost

EvaluationCost

•Continue process in 8 clinics•Bring CNHC clinics on line•Translate materials into Spanish•Continue to refine procedures•Monitor process•Collect data

Next Steps

• Partners in Cleveland and Cincinnati

• National Partners

•Policy Implications

Dissemination: Future Plans