Patient Navigation Program Research Articles

Implementation of financial toxicity screening and a novel financial navigation program.

290 Background: “Financial Toxicity” is the financial burden and stress imposed on a patient due to a disease and its associated treatment. About 50% of patients with gynecologic cancer experience financial toxicity. The aim of the study is to evaluate implementation of financial toxicity screening and a novel financial navigation program for patients with gynecologic oncology. Methods: Patients presenting for initial consultation with a gynecologic oncology provider from July 2022 to January 2023 were included. A new financial navigation program began in July 2022. On October 17, 2022, a financial toxicity screening question was added to new patient intake forms. We quantified patient referrals to the navigator before and after screening implementation, along with needs identified, action taken by the navigator and institutional support services utilized. Results: We included 458 new patients, 49% before and 51% after introduction of screening. The majority were white (61%) and had private insurance (59%) followed by Medicare (31%); median age was 59 (IQR 47-69). Following screening, a higher proportion of patients were referred to the financial navigator (15%) than before screening (4%, p<0.001). Additionally, referrals to other hospital social support services decreased from 9% before screening to 3% after (p<0.001). Uterine and cervical cancers were more prevalent in the 29 patients (12%) who screened positive (31% and 14% respectively) compared to those who screened negative (17% and 1%) or did not respond (24% and 4%). Referrals to the navigator included 59% of those who screened positive, 8% who screened negative and 10% who did not respond. Over six months, 62 patients (new and follow-up) were referred to the navigator. The most common need was transportation (21%) followed by financial assistance (16%) and emotional support (16%). The navigator assisted 11% of patients with transportation and referred 13% to financial counseling/billing and 27% to other resources. Conclusions: Implementing a financial toxicity screening question on intake forms was feasible, and increased identification of patients with financial toxicity and referrals to our financial navigator. Further investigation is needed to understand screening barriers and evaluate the program.

Nationwide analysis of legal barriers impacting patients with cancer and caregivers.

300 Background: The extent of legal barriers requiring appropriate navigation in patients following cancer diagnosis is unknown. We performed a nationwide analysis of a patient navigation program to investigate prevalence of such barriers. Methods: This retrospective analysis used the Triage Cancer Legal & Financial Navigation Program’s de-identified electronic database. Triage Cancer is a national, nonprofit organization that provides free education on legal issues that impact individuals diagnosed with cancer. Sociodemographic, financial, disease-site, and medical-legal navigation information were obtained for descriptive analysis. The main study outcome was the primary legal issue prompting a call to Triage Cancer for assistance. Associations between variables and the primary legal issue were explored with multinomial logistic regression analysis. Results: We investigated 2613 callers (1679 patients, 463 caregivers, 373 providers) between 2021-2023 in reference to patients who were 61% female, 57% aged 40-64y, 48% White, 37% employed, 32% on employer-sponsored insurance, and 45% with income <$50k. Breast (27%), hematologic (18%), and GI (10%) cancers were most common, and 39% of all patients were on treatment at time of call. Majority called for assistance with 1 (51%) or 2 (32%) legal barriers. Most common primary issue was health insurance (29% - insurance options, navigation, and appeals), followed by financial (20% - financial assistance or life insurance), disability (18% - applications and appeals), employment (17% - taking time off, working through treatment, returning to work, laid off, new job search, and unemployment benefits), and other (16% - housing, estate planning). Compared to health insurance, navigation for disability-related barriers was significantly higher among Black (OR 2.1) patients, and those with GI (OR 3.1) and lung cancer (OR 2.9) (Table). Employment barriers were higher among Black (OR 2.5) and Hispanic (OR 2.5) patients, and financial barriers among Black (OR 2.9), Hispanic (OR 2.4), and those on Medicaid (OR 2.9). Conclusions: This study highlights the prevalence of legal barriers impacting patients with cancer and their caregivers. It underscores an urgent need for accessible legal navigation programs, and potential for federal policy-level efforts in building legal safeguards to improve care.[Table: see text]

Breast cancer patient experiences in the Botswana health system: Is it time for patient navigators?

BackgroundNew models of care are required to support women with breast cancer due to rising incidence and mortality in sub-Saharan Africa (SSA). This study gives voice to the experiences of advanced-stage breast cancer patients in the Botswana healthcare system, to guide improved service provision and the potential utility of patient navigator (PN) programs. Methodsfocus group discussions (FGD) were conducted with advanced-stage breast cancer patients recruited from the oncology ward of the public Princess Marina Hospital located in Gaborone, Botswana. ResultsFGDs included 7 female breast cancer patients and their 7 caregivers (2 male and 5 females). Findings fell into the following themes: experiences with cancer diagnosis, experiences with treatment, roles of caregivers, information needs, views on cancer resources, and attitudes towards cancer research. The study identified several barriers across the cascade of care for breast cancer patients in the Botswana health system. These correspond to challenges with timely diagnosis and comprehensive management and highlight community level barriers to achieving the targets of the WHO Global Breast Cancer initiative (GBCI). ConclusionThe study findings suggest PN programs have the potential to bridge barriers identified in the Botswana healthcare system by improving communication, meeting information needs, providing emotional or practical support, and by addressing logistical barriers to cancer diagnosis and treatment in Botswana.

Barriers to Care Among Glaucoma Patients With a Missed Appointment and Interest in a Navigator Program.

Most glaucoma patients with missed appointments report barriers to care and social risk factors. One third expressed interest in engaging with a patient navigator program. Most expressed interest in rescheduling. The purpose of this study was to identify barriers to care among glaucoma patients with missed appointments and to assess their interest in a patient navigator program. A cross-sectional study involving adult glaucoma patients from an academic eye center who missed their scheduled appointment between April 18 and July 25, 2022. Participants were surveyed about reasons for missed appointments, barriers to care, social risk factors, and interest in consulting with our patient navigator program. Of 172 patients with a missed glaucoma appointment, 73% (126/172) were contacted, and 40% (51/126) of those completed the survey. Participant age averaged 67±14 years, half were female (25/51, 49%), and most identified as Black (27/51, 53%) or White (21/51, 40%). Barriers to seeing a doctor including difficulty scheduling appointments (13/51, 26%), transportation (12/51, 24%), and cost or insurance barriers (8/51, 16%). Twenty-eight (55%) respondents reported at least one social risk factor. A positive association was found between having at least one risk factor and expressing interest in consulting our patient navigator (odds ratio=6.7, P =0.009). Overall, a third of respondents expressed interest in engaging with our patient navigator program (17/51, 33%). Two thirds of participants reported awareness of missed appointments (34/51, 67%), of whom 35% (12/34) reported having already rescheduled, 41% (14/34) expressed interest in rescheduling, and 24% (8/34) did not wish to return. Glaucoma patients with missed appointments report barriers to care and face social risk factors. Telephone outreach may help to re-engage them with care, and patients expressed interest in a patient navigator program to address social needs.

Indigenizing and Ruralizing NCI Screen to Save Program: Resources, Optimizing Outreach, Teaching, Science (ROOTS)

Colorectal cancer (CRC) is a complex health disparity in many Indigenous and rural populations. While it affects anyone regardless of race, age, gender, or other common differences among people, Indigenous and rural populations are at a higher risk of dying from colorectal cancer. An NCI Screen to Save (S2S) program was culturally tailored to promote awareness and knowledge of colorectal cancer and screening in both Indigenous and rural communities across a sector in Northeastern USA. Indigenous and rural community outreach teams at an NCI-designated cancer center partnered with a community advisory board to provide an indigenized/ruralized version of the NCI Screen to Save program delivered to both Indigenous and rural/suburban communities. In total, n = 79 pre/post surveys were obtained from n = 82 participants, who had an average age of 49 years. Findings demonstrated that Indigenous/rural participants in both off-territory/non-reservation communities and a tribal community that received a culturally tailored version of NCI’s S2S program were able to identify both smoking and tobacco use along with lack of physical activity as risk factors for colorectal cancer. Post-intervention, participants reported being more likely to increase physical activity. Most importantly, participants said they would be more likely to be screened for colorectal cancer along with their family and friends based on their cancer screening experiences. Culturally tailored CRC messaging is an effective means for increasing screening intentions and decreasing cancer health disparities among both indigenous and rural populations. Future research should include the relationship of diet to obesity-related cancers, greater integration of Indigenous-rural patient navigation programs, creation of more information on genetic screening, and quality improvement to service translational science initiatives.

14 A Process Improvement Project to Increase Post-Emergency Department Discharge Appointment Scheduling at Local Hospital Specialty Clinics Utilizing Our Patient Navigation Program

14 A Process Improvement Project to Increase Post-Emergency Department Discharge Appointment Scheduling at Local Hospital Specialty Clinics Utilizing Our Patient Navigation Program

Identifying Risk Factors Associated with Repeated Referrals Within a Pediatric Navigation Program.

Approximately 1-in-5 children have a diagnosed mental, behavioral, and/or developmental disorder or delay by age 8 in the United States. Children with such conditions often require complex, complicated diagnostic and specialty care, making them susceptible to repeated referrals and ongoing unmet healthcare needs. Patient navigation programs (PNPs) are designed to integrate care from primary care providers to community-based services, using trained navigators to help patients and their families manage referrals and connect with referred services. This study examines factors associated with repeated referrals to an active PNP to inform ongoing referral patterns and adaptations to standard navigation support within a large healthcare system in South Carolina (SC). Data is sourced from the inception of the PNP in 2017 through 2022, including 15,702 referrals. Overall, 71.07% had no repeated referrals. Children who are older, diagnosed with attention deficit disorder(s), behavioral concerns, depression, multiple referral needs, and insured by Medicaid were found to be most susceptible to repeated referrals. Conversely, children who are non-Hispanic Black, were referred at a well-child visit, and are primarily insured by private insurance or Tricare were least likely to have repeated referrals. Children who are insured by Medicaid are more likely to be younger, identify as non-Hispanic Black, Hispanic, or another race/ethnicity, and have multiple needs at time of initial referral, identifying a potentially compounded risk for those who hold multiple risk factors to experiencing repeated referrals. Findings may inform adaptations to this PNP model to adjust navigator protocol for at-risk populations and equitably optimize referral-to-service connection.

Implementation of patient navigation program: Experience in Cipto Mangunkusumo Hospital as one of the first pilot projects in Indonesia.

104 Background: Successful cancer treatment depends on many factors, not merely only medical aspects, but also other things, such as patients’ ability to comply the treatment schedule, patients’ understanding of the treatment steps and process, to avoid delay in administrative process, etc. These non-medical aspects are significantly affects patients ability to complete the treatment, especially in developing country including Indonesia. This study aims to empower a group of patient navigator (PN) in a Radiation Oncology Unit in one of the biggest national top referral hospital in Indonesia, Cipto Mangunkusumo Hospital. Methods: For the preparation of the project, 14 lay patient navigators and 1 physical navigator who were all cancer survivors nor volunteer from the Cancer Information and Support Center (CISC) Group, were trained for basic patient navigation training and basic cancer knowledge, as well as communication skills training. The navigators also trained for emergency response (basic life support, hospital emergency codes and responses, etc). This program is under supervision of the American Cancer Society (ACS). As for the flow of the process, all new cancer patients in the Department will be introduced to PN for screening of their non-medical aspects potential barriers using a self-made questionnaire. Fourteen risk potential problems are listed in the questionnaires, including accommodation, transportation, financial, psycho-social and family/support system problems. Results: The program was launched in September 2022 in the Department of Radiation Oncology Cipto Mangunkusumo Hospital. Patients with all cancer types are included in the program. Until Feb 2023, more than 500 patients have been screened for their potential barriers in going through the treatment. Most of the significant helps given by the PN were allocating a free accommodation for the patients living far from the hospital, free transportation pick up to the hospital, home visits for those who drop outs from treatment and give the supports needed to come back to therapy, and psychosocial-emotional supports. Conclusions: Patient navigation program in our Department was found to be effective in helping our cancer patients completing their treatment.

15 Development of a student-led cervical cancer patient education and navigation program

15 Development of a student-led cervical cancer patient education and navigation program

Emergency department patient navigators successfully connect patients to care within a rapidly evolving healthcare system

In the United States, adherence to follow up medical appointments among patients discharged from the emergency department varies between 26% and 56%, depending on the population. It is well known that patients face significant barriers to care within an increasingly complicated system of care. In an effort to better support patients, in 2020, NewYork-Presbyterian Queens implemented a Patient Navigator Program with 7 bilingual Patient Navigators who were trained to deliver culturally sensitive education and support, and to schedule follow up appointments for patients experiencing barriers to care. Between February 2020 and December 2022, 30,164 patients were supported by the 7 Patient Navigators. Ninety-four percent of patients without a primary care provider had a new provider and appointment upon discharge, and 81% of patients attended the appointment scheduled by the Patient Navigator. This study demonstrates that Patient Navigators can work alongside clinical colleagues, and as members of emergency department health care teams, to support patients to connect to care and to attend follow up appointments. It also highlights that Patient Navigators are uniquely qualified to build trust and to support patients to achieve appropriate, continuous care within a rapidly evolving health care system.

Pilot Evaluation of the Family Bridge Program: A Communication- and Culture-Focused Inpatient Patient Navigation Program

ObjectiveChildren with low income and minority race and ethnicity have worse hospital outcomes due partly to systemic and interpersonal racism causing communication and system barriers. We tested the feasibility and acceptability of a novel inpatient communication-focused navigation program. MethodsMultilingual design workshops with parents, providers, and staff created the Family Bridge Program. Delivered by a trained navigator, it included 1) hospital orientation; 2) social needs screening and response; 3) communication preference assessment; 4) communication coaching; 5) emotional support; and 6) a post-discharge phone call. We enrolled families of hospitalized children with public or no insurance, minority race or ethnicity, and preferred language of English, Spanish, or Somali in a single-arm trial. We surveyed parents at enrollment and 2 to 4 weeks post-discharge, and providers 2 to 3 days post-discharge. Survey measures were analyzed with paired t tests. ResultsOf 60 families enrolled, 57 (95%) completed the follow-up survey. Most parents were born outside the United States (60%) with a high school degree or less (60%). Also, 63% preferred English, 33% Spanish, and 3% Somali. The program was feasible: families received an average of 5.3 of 6 components; all received >2. Most caregivers (92%) and providers (81% [30/37]) were "very satisfied." Parent-reported system navigation improved from enrollment to follow-up (+8.2 [95% confidence interval 2.9, 13.6], P = .003; scale 0–100). Spanish-speaking parents reported decreased skills-related barriers (−18.4 [95% confidence interval −1.8, −34.9], P = .03; scale 0–100). ConclusionsThe Family Bridge Program was feasible, acceptable, and may have potential for overcoming barriers for hospitalized children at risk for disparities.

From Awareness to Action: A Review of Efforts to Reduce Disparities in Breast Cancer Screening.

Breast cancer is a significant public health concern, and addressing disparities in breast cancer screening is crucial for improving early detection and reducing mortality rates. This review article examines efforts to bridge the gap between awareness and action in reducing disparities in breast cancer screening. A systematic approach was employed to gather relevant literature using various databases. The selected studies encompassed a range of interventions, including policy changes, community-based programs, culturally competent interventions, technological advancements, and patient navigation. The review highlights the importance of policies and legislation in improving access to screening services and the impact of community-based initiatives in addressing disparities. Culturally competent interventions, tailored messaging, and language support were found to be effective in improving screening rates among diverse populations. Technological advancements, such as telemedicine and mobile health applications, were identified as promising approaches to increase access to screening services. Patient navigation programs effectively addressed barriers to screening and improved screening rates. The review also discusses evaluating efforts, limitations, and the need for continuous improvement. Future directions and recommendations include addressing gaps in the existing literature, proposing research directions, and providing recommendations for policymakers, healthcare providers, and researchers. By implementing these recommendations and working collaboratively, we can strive for equitable access to breast cancer screening for all populations, ultimately leading to improved outcomes and reduced disparities.

Patient navigation educational curriculum for cancer care in Mexico.

e18592 Background: In Latin America (LatAm), cancer is a major public health issue with high mortality rates. Patient navigation (PN) programs have emerged as a strategy to improve access to cancer care for underserved populations. Unfortunately, there is a lack of educational opportunities for those willing to become patient navigators in LatAm. The aim of this study was to develop and implement an educational PN curriculum for healthcare workers interested in improving cancer care in Mexico. Methods: A multidisciplinary team of national top-level cancer experts designed an online comprehensive PN curriculum, which was implemented online following the ECHO model. It consisted of a four-day virtual conference including virtual lectures and workshops. Participants were ask to develop or improve PN programs tailored for their specific institutional needs. After the conference, attendees were tasked with implementing their planned programs. They participated in eight monthly conference video calls designed to reinforce PN project implementation, assist in overcoming barriers and continue conversations with expert faculty. Participants completed pre- and post- course knowledge and satisfaction questionnaires. Progress of participants’ individual goals implementation was assessed at 4 and 8 months after the conference. Results: 28 participants attended the online conference, 56% of them were physicians, 16% psychologists, 4% nurses, and 4% social workers. 89% worked in a public hospital, 72% took care of adults with solid cancer, and 28% of children with hematologic/solid cancers. 93% considered the program was excellent and 100% that the information improved their knowledge. Participants’ baseline knowledge score was 66% (range 27-76%) with a significant increase in the proportion of correct answers of 12% (p < 0.01) at the end of the program (final score 74%; range 58-84%). At 4- and 8-month follow-up, participants reported 54% and 60% of progress regarding their goals on implementing a PN program at their institutions. Most common barriers to PN program implementation were communication issues with other healthcare providers in 44% of participants, and lack of financial support in 11%. At 8 months, most participants felt that they were well prepared for providing PN for patients with cancer (mean = 4.2/5; SD 0.42); and well prepared for managing patient and institutional barriers for cancer care (mean = 4/5; SD 0.67). Conclusions: Our results showed that implementing a virtual educational PN curriculum was feasible, that healthcare providers' knowledge on PN topics significantly increased and that it helped with their PN implementation plans. Educational PN programs like the one we propose could help and guide healthcare providers to implement PN programs for cancer care at institutions across countries in LatAm, where patients face similar barriers for accessing cancer care.

Disparities in lung cancer screening in a diverse urban population and the impact of a community-based navigational program.

6555 Background: Lung cancer (LC) is the leading cause of cancer death in the US in both men and women; causing 25% of all cancer deaths. Annual lung cancer screening (LCS) with a low-dose CT (LDCT) in high-risk individuals (aged 50-80 with a >20 pack-year smoking history) decreases LC deaths by 20% and is recommended by USPSTF. Despite the efficacy, uptake of LDCT remains low at 6% nationally, and 13% in Rhode Island. Patient (pt) and provider perceived barriers, along with racial, ethnic and socioeconomic disparities widen the gap. We evaluated the implementation of a LCS navigation program at an urban community health center (CHC) with a multiethnic, socioeconomically underserved population. Methods: A bilingual (English and Spanish speaking) pt navigator was integrated into routine clinic practice at a large primary care CHC group, across 4 sites, starting in January 2022. The navigator’s role was to assess pt and provider awareness of the LCS process, assess for systemic barriers, and provide navigational support for the LDCT process. Pts eligible for LCS at the CHC from 1/2022 to 12/2022 were retrospective examined; 50 to 80 years and a >20 pack-year smoking history. The navigator administered a questionnaire to assess barriers to LDCT and demographic variables. Results: A total of 360 eligible pts were seen across the CHC practice in 2022, of which 149 (41.4%) agreed to undergo LDCT after counseling and shared decision making and 28% of these (n 101) completed LDCTs. 153 of the eligible pts completed the survey questionnaire. Of these, 50% were females; 40% were Hispanic/Latinx, 40% were non-Hispanic/Latinx and 22% declined to answer. Majority, 61% were white, 10% African American/Black and 28% declined to answer. A sizeable proportion were non-English speaking (34%) and resided in cities with Rhode Island’s lowest per-capita incomes (Pawtucket 48%), Central Falls (32%) and North Providence/Providence (10%). In assessing barriers to LCS, 46% of pts were not aware of the LCS process and 44% were unaware that LCS was covered by health insurance; 58% of eligible pts did not recall their PCP discussing LCS. Of the LDCTs resulted available at the time of analysis, 84% were Lung RADS-1 and 16% Lung RADS-4 category. Conclusions: Our study highlights the unique barriers to LCS in an urban multiethnic community. While access to LCS remains an issue, pt awareness of the lung cancer screening process was the major barrier. A patient navigation program is critical to the success of LCS in a community, by providing education to patients and providers and the necessary logistical support needed in the LDCT process. With a community based navigational program, we demonstrate a significant increase in lung cancer screening rates in our population to 28% as compared to the state LCS rate of 13%. (Supported by the Robert A. Winn Diversity in Clinical Trials Career Development Award).

Abstract 15: Breast Cancer Patient Experiences in the Botswana Health System: Is it Time for Patient Navigators?

Abstract Purpose: New models of care are required to support women with breast cancer due to rising incidence and mortality in sub-Saharan Africa. We evaluated experiences of breast cancer patients and their caregivers in Botswana to identify opportunities to improve service provision. Methods: Focus Group Discussions (FGD) were conducted to gather insights on the experiences of breast cancer patients navigating the healthcare system. A purposive sampling technique was employed to recruit participants from the oncology ward of Princess Marina Hospital in Gaborone, Botswana. FGDs included 7 female breast cancer patients and 7 caregivers (2 male and 5 females). A semi-structured interview guide with probes was used to collect data. Results: Key emergent themes included patients’ experiences with healthcare professionals; delays in diagnosis; experiences with cancer treatment; information needs; views on cancer resources; the role of caregivers and attitudes towards cancer research. Patients reported experiencing poor communication or a lack of empathy from healthcare providers when receiving a diagnosis. Social support and spiritual beliefs were important to patients in handling the diagnosis. Delays in diagnosis were reported due to logistical challenges, poor appointment and referral systems, as well as delayed or missing laboratory results. Similar experiences with cancer treatment were reported including a lack of timely access to treatment and poor communication regarding chemotherapy and adverse effects. Patient and caregiver information needs, therefore, largely focused on a desire to understand chemotherapy side-effects and the biological nature of breast cancer. Discussions regarding availability of cancer resources revealed a lack of basic services to maximize patient comfort and difficulties accessing specialized cancer care infrastructure. Caregivers were found to have a largely positive role in providing emotional and practical support. Patients and caregivers appreciated the utility of cancer research in improving treatment. Conclusion: A number of barriers exist across the cascade of care for breast cancer patients in the Botswana health system. Although patient navigator programs may not address all barriers, they have potential utility in the context of improving communication, meeting information needs and providing emotional or practical support by addressing logistical barriers to cancer diagnosis and treatment in Botswana. Citation Format: Kirthana Sharma, Leyla Baghirova, G Gulubane, Shaheen Abkenari, Tapologo Leselwa, Morongwa Legwaila, Reena Antony, Refeletswe Lebelonyane, Peter Vuylsteke, Richard Marlink, Tendani Gaolathe, Tiny Masupe. Breast Cancer Patient Experiences in the Botswana Health System: Is it Time for Patient Navigators? [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 15.

Social Determinants of Health Screening and Management: Lessons at a Large, Urban Academic Health System.

In October 2022 a multisite social determinants of health screening initiative was expanded across seven emergency departments of a large, urban hospital system. The aim of the initiative was to identify and address those underlying social needs that frequently interfere with a patient's health and well-being, often resulting in increased preventable system utilization. Building on an established Patient Navigator Program, an existing screening process, and long-standing community-based partnerships, an interdisciplinary workgroup was formed to develop and implement the initiative. Technical and operational workflows were developed and implemented, and new staff members were hired and trained to screen and support patients with identified social needs. In addition, a community-based organization network was formed to explore and test social service referral strategies. Within the first five months of implementation, more than 8,000 patients were screened across seven emergency departments (EDs), of which 17.3% demonstrated a social need. Patient Navigators see between 5% and 10% of total nonadmitted ED patients. Among the three social needs of focus, housing presented as the greatest need (10.2%), followed by food (9.6%) and transportation (8.0%). Among patients identified as rising/high risk (728), 50.0% accepted support and are actively working with a Patient Navigator. There is growing evidence to support the link between unmet social needs and poor health outcomes. Health care systems are uniquely positioned to provide whole person care by identifying unresolved social needs and by building capacity within local community-based organizations to support those needs.

Development of a navigation program for patients undergoing hematopoietic stem cell transplantation

To develop a navigation program for patients undergoing hematopoietic stem cell transplantation. Method: The study followed the convergent care research methodology, which provides the researcher's participatory insertion in the field of care practice. The navigation program was divided into four stages: diagnosis, planning, implementation and evaluation. The diagnostic stage consisted of understanding the sector's routine and listing the barriers faced by patients. In the planning phase, the program and its operation were structured. The implementation took place through a pilot study with patients undergoing transplantation. In the evaluation stage, the data were analyzed using the continuous improvement tool (Plan, Do, Check and Correct). Results: The sample consisted of 21 adult patients. The most frequent pathology was acute lymphocytic leukemia, the prevalent sex was male, two patients died during the preparation for the procedure, and only one required readmission after hospital discharge. Conclusion: The development of a navigation program proved to be essential for the adaptation of the patient and family to the new sector and routine, and contributed to greater user satisfaction.

Interprofessional Collaborative Practice: Management of Chronic Disease and Mental Health Issues in Primary Care.

This case study describes the process of implementing and evaluating an interprofessional collaborative practice (IPCP) program for primary care and behavioral health integration focused on chronic disease management. The result was a strong IPCP program in a nurse-led federally qualified health center serving medically underserved populations. The IPCP program at the Larry Combest Community Health and Wellness Center at the Texas Tech University Health Sciences Center spanned >10 years of planning, development, and implementation, supported by demonstration, grants, and cooperative grants from the Health Resources and Services Administration. The program launched 3 projects: a patient navigation program, an IPCP program for chronic disease management, and a program for primary care and behavioral health integration. We established 3 evaluation domains to track the outcomes of the program: TeamSTEPPS education outcomes (Team Strategies and Tools to Enhance Performance and Patient Safety), process/service measures, and patient clinical and behavioral measures. TeamSTEPPS outcomes were evaluated before and after training on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Mean (SD) scores increased significantly in team structure (4.2 [0.9] vs 4.7 [0.5]; P < .001), situation monitoring (4.2 [0.8] vs 4.6 [0.5]; P = .002), and communication (4.1 [0.8] vs 4.5 [0.5]; P = .001). From 2014 to 2020, the rate of depression screening and follow-up improved from 16% to 91%, and the hypertension control rate improved from 50% to 62%. Lessons learned include recognizing partner contributions and the worth of each team member. Our program evolved with the help of networks, champions, and collaborative partners. Program outcomes show the positive impact of a team-based IPCP model on health outcomes among medically underserved populations.

Older adults with complex care needs’ experiences within a hospital-to-home transition patient navigator program: A qualitative descriptive study

Introduction Older adults living with complex care needs are often hospitalized due to poor community support. Recommendations for improving patient and family experiences include having a patient navigator to support patients and caregivers in hospital and community settings. This study aimed to report on older adults’ and caregivers’ experiences of receiving services from a hospital-to-home patient navigation program. Methods A qualitative descriptive study was conducted. Telephone interviews were conducted with 14 older adults with complex care needs or their family caregivers in Toronto, Ontario from 2020 to 2021. Data were analyzed using inductive thematic analysis. Results Four themes were identified: (1) Initial Hesitancy; (2) Meeting Evolving Needs; (3) Unexpected Benefits of Patient Navigation; and (4) The Value of Patient Navigation in Sustaining Aging-in-Place. Participants viewed all their interactions with the navigator as positive, and perceived navigators improved their quality of care. Discussion These study findings suggest that patient navigators may be well-positioned to address gaps in services around psychosocial support and care coordination while also encouraging self-management in older adults with complex care needs.

Influence of a patient navigation program on timeliness of care in patients with esophageal cancer

Patient navigation (P.N.) is designed to eliminate barriers to care. The objective of this study was to evaluate the impact of a novel P.N. program on timeliness of care in patients with esophageal cancer. This retrospective study compared the timeliness of care for esophageal cancer patients before (January 2014-March 2018) and after the implementation of a novel P.N. program (April 2018-March 2020), called EDAP, at a tertiary care center. The primary outcome was time from biopsy to first treatment; secondary outcomes included time from biopsy to complete staging, biopsy to complete preoperative workup, and referral to the first point of contact. The outcomes were evaluated in the entire cohort and then in a subgroup of patients undergoing curative multimodality therapy. There were 96 patients in the pre-EDAP group and 98 patients in the post-EDAP group. There was no significant difference between pre- and post-EDAP in the time from biopsy to first treatment and time from biopsy to staging in the overall cohort. In the subgroup of patients undergoing curative multimodality therapy, there was a significant decrease in time from biopsy to first treatment postnavigation (60-51 days, p = 0.02), in addition to a significant decrease in time from biopsy to preoperative workup and time from biopsy to staging. This is the first study demonstrating that a novel P.N. program for patients with esophageal cancer improved timeliness of care. The group of patients who benefited most were those undergoing curative multimodality therapy, likely given the extensive coordination of services required by this group.