The Impact of Patient Navigation on the Quality of Colorectal Cancer Screening: Results from the Provider and Community Engagement (PACE) Program in Franklin County, Ohio

Abstract

Introduction: Colorectal cancer (CRC) screening rates are lowest among racial/ethnic minorities and those of low socioeconomic status (SES). These groups are also at greatest risk for suboptimal bowel prep, one of several colonoscopy quality indicators. Patient navigation (PN) is an evidence-based intervention that was developed as a means to address barriers to cancer screening. In March 2015, we piloted a PN program within our Provider and Community Engagement (PACE) Program to reduce disparities in the quality of colonoscopy-specific colorectal cancer screening. Aim: Determine the impact of PN on colonoscopy quality indicators among racial/ethnic minorities with low SES. Methods: We performed a retrospective chart review of all patients who participated in the pilot PN program. Only those who underwent an average-risk screening colonoscopy (SC) were included in the primary analysis. They were compared to all individuals who underwent a SC by one of the eight endoscopists participating in the PN program within the prior six months. Propensity score matching (based on age, race, ethnicity, gender, preferred language, smoking and diabetes status, and aspirin usage) was used to identify controls from this group. Patients with multiple colonoscopies were excluded. Demographic characteristics and colonoscopy quality indicators (bowel prep score, cecal intubation rate, adenoma detection rate, serrated polyp detection rate, advanced adenoma detection rate and adenoma per colonoscopy) were compared between matched groups by mixed effect models for continuous variables or conditional logistic regression for categorical variables. Insurance status was used as a surrogate for SES and we equated Medicaid and self-pay with low SES. Results: During the study period, 45 out of 51 (88.2%) colonoscopies in the PN group were average risk, compared to 608 out of 710 (85.6%) in the control group (p = 0.61). Following propensity score matching, 90 controls were compared to 45 individuals in the PN group in the primary analysis. Overall, a significantly greater proportion of participants in the PN cohort were self-pay or on Medicaid as compared to the control group (93% vs 48%; p Conclusion: Patients of low SES who received PN had colonoscopy quality measures that did not differ from the control group with higher SES. These results inform clinical practice and support the use of PN for improving the quality of SC among low SES patients, a population at greatest risk for suboptimal bowel prep and low SC uptake.Table 1: Demographic characteristics among average-risk participants who underwent a screening colonoscopyTable 2: Colonoscopy quality indicators among average-risk participants who underwent a screening colonoscopy