Patient Navigation Model Research Articles

“I think like if Albert Einstein and Superman had a baby, that's what it would take”: The experiences and perceptions of community and hospital healthcare professionals in a seniors’ patient navigator program

Introduction The success of new patient navigation programs have mostly been described from the perspectives of patient outcomes. Little is known about how patient navigators interact with healthcare professionals in the community and in hospital settings. Methods A qualitative study using a phenomenological analysis was undertaken to depict the lived experiences of Ontario (Canada) healthcare providers who have interacted with a patient navigator. Semi-structured interviews were conducted with 42 healthcare professionals, including frontline care providers ( n = 25) and administrators ( n = 16) from hospital ( n = 21) and community care settings ( n = 21). Results Participants’ experiences were reflected in one overarching theme: role clarity and three emergent themes related to the overarching theme: (i) concerns over accountability of patient care (ii) trust (iii) attainable-but-not. Participants described an inconsistent understanding of the role of patient navigators which led to uncertainty regarding their role in patient care. The current nature of the healthcare system influenced participants’ belief in the sustainability of patient navigation model of care. Despite these experiences, participants felt that patient navigators could help healthcare providers care for patients by preventing potential crises from developing and enhancing their knowledge about services. Discussion This study expands our understanding of patient navigation programs by exploring the experiences and perceptions of healthcare professionals, thereby providing new perspectives into components that support the successful health outcomes of older adults being supported by a patient navigator. The implications of findings for research, clinical practice, and policy are described.

999 Patients with which high risk complication benefits the most from patient navigation?

Maternal Morbidity Review Committees recognize social determinants of health contribute to poor maternal outcomes. Historically, low income women have a poor postpartum follow up (49.4%) and contraception use rate (47.5%). Racial disparities are prevalent within low income population. Our objective was to determine which group of patients with high risk conditions in our low income population had improvement in perinatal outcomes as a result of patient navigation. A retrospective cohort study was performed on low income pregnant patients from January 2016 to December 2017. Our patient navigation model was an interdisciplinary team, consisting of a physician, care coordinator, patient navigator, and social worker. Cohorts were determined by high risk condition: history of obstetric vs. medical complications. The primary outcomes were delivery at our institution and postpartum follow up. Secondary outcomes included rates of breastfeeding, contraception use, > 4 prenatal visits, and prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination. Outcomes were compared using bivariate analysis. 724 patients were included in analysis. Baseline demographics were similar between groups. 691 (95%) of patients delivered at the institution where they had obtained prenatal care. Overall postpartum follow up rate was 72%. There was a significant difference in postpartum follow up rate, and delivery at home institution between the two groups. There were no significant differences found between contraception use or breast feeding. There was a high rate of delivery at a single urban institution. The postpartum follow up, contraception use, and breastfeeding rates in both groups was higher than historically reported in a similar population. This suggests that patient navigation models can be used to mitigate socio-economic disparities in healthcare. There was a statistically significant lower postpartum follow up rate in the obstetric complication group, which may reflect a need to increase education regarding recurrences risk in future pregnancies.

Apoyo con Cariño: A Qualitative Analysis of a Palliative Care-Focused Lay Patient Navigation Intervention for Hispanics With Advanced Cancer.

A lay patient navigator model involving a culturally tailored intervention to improve palliative care outcomes for Hispanics with advanced cancer was tested across 3 urban and 5 rural cancer centers in Colorado. Five home visits were delivered over 3 months to 112 patients assigned to the randomized controlled trial's intervention arm. Grounded in core Hispanic values, visits addressed palliative care domains (advance care planning, pain/symptom management, and hospice utilization). To describe the content of patient navigator visits with patients/family caregivers, research team members analyzed 4 patient navigators' field notes comprising 499 visits to 112 patients. Based on previous work, codes were established a priori to identify ways patient navigators help patients/family caregivers. Key words and comments from field notes were classified into themes using ATLAS.ti and additional codes established. Nine common themes and exemplars describing the lay patient navigator role are described: activation/empowerment, advocacy, awareness, access, building rapport, providing support, exploring barriers, symptom screening, and the patient experience. Patient navigators used advocacy, activation, education, and motivational interviewing to address patient/family concerns and reduce barriers to quality palliative care in urban and rural settings. Adapting and implementing this model across cultures has potential to improve palliative care access to underserved populations.

Abstract A087: Community Research Navigators (CRN): The bridge to increasing Latino participation in clinical research

Abstract The participation of underserved ethnic minorities in biomedical research is critical to achieving progress in health equity. Increasing ethnic minority including Latino accrual in biomedical research, including clinical trials, is a formidable challenge that requires improving participant trust and commitment and overcoming of barriers to participation. Latinos make up about 18% of the US population. Yet Latinos are not adequately targeted in research studies, currently constituting only 7.6% of NIH clinical trial participants and only about 2%-5% of participants in cancer clinical trials. The National Cancer Institute (NCI) has recommended patient navigation as a research strategy that may be adapted to overcome ethnic minority biomedical research and clinical trial participation barriers. City of Hope has participated in training community research navigators (CRN) to increase diversity participation. These CRNs are trained to address gaps in knowledge, medical mistrust, access to participation, and engagement of under-represented groups in biomedical research. The research navigator draws from the patient navigation and promotora model and the community-engaged research approach. CRNs' curriculum include the importance of biomedical to disease prevention, diagnosis, and treatment; the value to group and family participation, Clinical Trials, HIPPA, human subject protection, ethics; patient-provider communication, cost and coverage, and family communication and decision making. In total, we trained and mentored a team of 30 CRNs from our community partner Pomona's Health Promoters for increased public education and Latino participation in research. CRNs were 25-74 years old, 97% female, 96% foreign-born, and 54% < high school education. Their pre- and post-test results showed an increase in willingness to participate in research (p < .005); increase in knowledge of the importance of biomedical including clinical research (p < .000); and an increase in confidence in improving community's attitude and knowledge about clinical research (p < .000). Our findings suggest that the CRN training is effective in improving appropriate knowledge and confidence to conduct community research navigation. This approach holds the promise of utility and applicability to address barriers to research enrollment and increase Latino biomedical research participation. Citation Format: Mayra Serrano, Marisela Garcia, Rick Kittles, Kimlin Tam Ashing. Community Research Navigators (CRN): The bridge to increasing Latino participation in clinical research [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A087.

Abstract B033: Patient navigation at NCI-designated, safety-net, and rural cancer centers: Why is tailoring necessary?

Abstract Introduction: Recent studies suggest where patients receive cancer care is a determinant of survivorship outcomes. As a culturally and individually tailored approach to addressing barriers to cancer care and other contributors to cancer disparities, patient navigation (PN) is an effective strategy to enhance the efficiency of healthcare systems and continuity of care. Patient navigation programs have emerged as a strategy to reduce morbidity and mortality for cancer and associated late and long-term effects of treatment. This study utilized the Community-Based Participatory Research (CBPR) framework to evaluate an enhanced ‘care coordination model’, linking navigators with cancer patients at an NCI-designated cancer center, a safety-net hospital cancer center, and a rural hospital cancer center. The purpose of this study is to characterize the implementation of the patient navigation model in three unique clinical settings for cancer care delivery. Methods: Eligible participants were identified from the partnership between Morehouse School of Medicine (MSM), Tuskegee University (TU) and the O’ Neal Comprehensive Cancer Center at UAB sites by the health-systems patient navigator (HSPN). The HSPN screened patients to assess their need for navigation services. Those in need of navigation were introduced to the study at their prospective treatment facilities. Patients were linked with community-based patient navigators (CBPNs) to ensure continuity of addressing the clinical and non-clinical effects of treatment. Findings: Navigators aided with service requests; however, there were differences in the types of services requested based on cancer center and treatment status. Participants who were in treatment the NCI-designated cancer center (n=35) were mostly Black (62.9%), female (91.4%), single (45.7%), employed (34.3%), had Medicare (28.6%) and a yearly household income $5,001 to $10,000. They mostly requested assistance with gas (88.6%), social support (74.3%) financial assistance (48.6%), and lodging (20%). Participants who completed treatment at the safety-net hospital cancer center (n=20) were mostly Black (85%), female (80%), single (50%), disabled (45%), had Medicaid (55%), and a yearly household income of less than $5,000 a year (23.5%) and $15,001 -$25,000 (23.5%) a year. These survivors requested assistance with food procurement (75%), financial assistance (50%), education (35%), transportation (25%), and clothing (25%). Participants who were in treatment at the rural hospital cancer center (n=4) were all Black (85%), mostly male (75%), and half were married (50%). These survivors requested assistance with transportation (50%) and financial assistance (50%). Conclusion: The work of navigators, whether they are health-systems or community patient navigators, is dynamic and valuable to the care of cancer survivors, especially for disparate populations. The adaptability of this model based on the dynamics of the clinical setting emphasizes the utility of this model. Citation Format: Dexter L Cooper, Vivian Carter, Natalie D Hernandez, Mindy Le, Kimberly Robinson, Shawn J Ennis, Mona Fouad, Brian M Rivers. Patient navigation at NCI-designated, safety-net, and rural cancer centers: Why is tailoring necessary? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B033.

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Patient navigator reported patient barriers and delivered activities in two large federally-funded cancer screening programs

Few data are available on patient navigators (PNs) across diverse roles and organizational settings that could inform optimization of patient navigation models for cancer prevention. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Colorectal Cancer and Control Program (CRCCP) are two federally-funded screening programs that support clinical- and community-based PNs who serve low-income and un- or underinsured populations across the United States. An online survey assessing PN characteristics, delivered activities, and patient barriers to screening was completed by 437 of 1002 identified PNs (44%). Responding PNs were racially and ethnically diverse, had varied professional backgrounds and practice-settings, worked with diverse populations, and were located within rural and urban/suburban locations across the U.S. More PNs reported working to promote screening for breast/cervical cancers (BCC, 94%) compared to colorectal cancer (CRC, 39%). BCC and CRC PNs reported similar frequencies of individual- (e.g., knowledge, motivation, fear) and community-level patient barriers (e.g., beliefs about healthcare and screening). Despite reporting significant patient structural barriers (e.g., transportation, work and clinic hours), most BCC and CRC PNs delivered individual-level navigation activities (e.g., education, appointment reminders). PN training to identify and champion timely and patient-centered adjustments to organizational policies, practices, and norms of the NBCCEDP, CRCCP, and partner organizations may be beneficial. More research is needed to determine whether multilevel interventions that support this approach could reduce structural barriers and increase screening and diagnostic follow-up among the marginalized communities served by these two important cancer-screening programs.

Abstract 2430: Assessing patient navigation and support services at FQHCs

Abstract Cancer is the leading cause of morbidity and mortality for Latinx followed by African Americans (CDC, 2017). Screening can increase the rate of early detection and treatment success. However, the rates of compliance for screening are typically lower among Latinx, which may contribute to decreased diagnosis and increased risk of disease in comparison to their Euro-American counterparts (ACS, 2015). Access to screening services and ability to pay are among the commonly cited barriers for screening compliance. The IDPH recommends incorporating patient navigator (PN) models in community health clinics and communitywide events to increase health literacy, knowledge, and delivery, and quality of care including compliance with screening methods. The University of Illinois (UI) Cancer Center (UICC) works in partnership with the UI Health Mile Square Health Center (MSHC) to implement a bilingual, bicultural PN model for conducting comprehensive cancer prevention and screening services among Latinx, African Americans, and underserved communities in Chicago. A mixed methods approach was used to evaluate the patients’ perceptions and experiences with patient navigator encounters and support services. The authors conducted a semi-structured interviews and abstracted data from patient records. Provider interviews were conducted to understand provider knowledge and attitudes of navigator services. Navigator interviews captured benefits and challenges of incorporating navigation services at the clinics. Data were entered in REDCap and analyzed using Dedoose v. 8.0.42. This paper validates the implementation of PN models at federally qualified health centers (FQHCs) as an asset to patients and providers in facilitating health education, increasing patient screening compliance, and improving access to health care services. Comprehensive cancer screening maximizes resources and improves the quality of life and health outcomes of underserved Latinx and African American patients who are navigated to services. PN-provider partnerships are introduced as a hallmark of the program’s success in identifying at-risk patients and navigating them to appropriate and timely medical screening, diagnostic, and treatment services. Future directions for incorporating and evaluating culturally responsive, bilingual, bicultural PN models at FQHCs, community clinics, and school based clinics are shared to inform public policy for rapid cycle monitoring of protective health cancer interventions and early detection services for Latinx and African American patients in Chicago. Citation Format: Lisa Aponte-Soto. Assessing patient navigation and support services at FQHCs [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2430.

FRI-232-An outpatient endoscopy-based patient navigator model improves hepatitis C virus screening among high risk patients: A 3-year prospective observational study among a safety-net health system

FRI-232-An outpatient endoscopy-based patient navigator model improves hepatitis C virus screening among high risk patients: A 3-year prospective observational study among a safety-net health system

Bibliometric Analysis of Patient Navigation Model Applied in Colorectal Cancer Care Based on Web of Science

Background: The mortality rate of colorectal cancer in China is on the rise, which has exceeded the global average rate, thus making the care of colorectal cancer widely concerned. As a comprehensive nursing model, the patient navigation model has shown its effectiveness in improving the quality of life among patients with chronic diseases and reducing the shortage of current healthcare resources in some area. This study aims to identify the current status and dilemma of the patient navigation model applied in colorectal cancer care in China. Methods: Bibliometric method was used to analyze published articles regarding the application of patient navigation model in colorectal cancer care retrieved from the Web of Science database. Statistics were presented using visualization method processed by the Bibliographic Items Co-occurrence Matrix Builder (BICOMB) software. Results: 124 articles, from 2006 to 2018, covering 14 countries, involving 931 researchers, 356 institutions and 60 publications were obtained; American research papers are the largest components of the aforementioned articles; only one of them is written by Chinese authors. The 3 leading institutions in this domain are University OF Rochester, Ohio State University, Icahn School of Medicine at Mount Sinai, yet the distribution of authors is relatively decentralized. “Cancer” is the main journal that publishes the researches in this domain. Research hotspots are on “cancer prevention and screening”, “health disparities”, “economic evaluation”, “patient navigators”, and “ethnicity”. Conclusion: In China, the research on the patient navigation is still in its infancy. Therefore, the Chinese government should provide more endorsement to this particular area and encourage the cooperation with other countries. China, having a long way to go, should further explore patient navigation on colorectal cancer care and establish a model that matches its cultural backgrounds.

The Chinatown Patient Navigation Program: Adaptation and Implementation of Breast and Cervical Cancer Patient Navigation in Chicago's Chinatown.

Background:As health care reform continues within the United States, navigators may play increasingly diverse and vital roles across the health care continuum. The growing interest in patient navigation programs for underserved populations calls for detailed descriptions of intervention components to facilitate implementation and dissemination efforts.Methods:In Chicago’s Chinatown, Chinese immigrant women face language, cultural, and access barriers in obtaining breast and cervical cancer screening and follow-up. These barriers spurred the research partnership between Northwestern University, the Chinese American Service League, Mercy Hospital & Medical Center, and Rush University Medical Center to formalize the Chinatown Patient Navigation Collaborative for adapting and implementing previously developed patient navigation models.Results:In this report, we describe the adaptation of patient navigation to build the Chinatown Patient Navigation Collaborative’s community-based patient navigation program for breast and cervical cancer. We offer insights into the roles of community patient navigators in safety net hospital and underserved Chinese immigrant communities, and describe implications for patient navigation initiatives to maximize community benefits by improving access to health care for vulnerable populations.Conclusions:Our adaptation and implementation of a patient navigation intervention in Chicago’s Chinatown illustrates promising approaches for future navigator research.

The Influence of Housing Status on the HIV Continuum of Care: Results From a Multisite Study of Patient Navigation Models to Build a Medical Home for People Living With HIV Experiencing Homelessness.

Objectives. To examine the effect of patient navigation models on changes in housing status and its subsequent effects on HIV outcomes for 700 people living with HIV (PLWH) who were unstably housed with co-occurring substance use and psychiatric disorders across 9 demonstration sites in the United States between the years of 2013 and 2017.Methods. Self-reported housing status was collected at baseline, and at 6 and 12 months during the intervention. HIV outcomes included linkage and retention in care, antiretroviral therapy prescription, and viral suppression collected via chart review.Results. In the 12 months after the intervention, 59.6% transitioned to more stable housing. Compared with those who became or remained unstably housed, participants with greater stability achieved significantly higher rates of retention (adjusted odds ratio [AOR] = 2.12; 95% confidence interval [CI] = 1.11, 4.05), were more likely to be prescribed antiretroviral therapy (AOR = 2.06; 95% CI = 1.62, 2.63), and had higher rates of viral suppression (AOR = 1.62; 95% CI = 1.03, 2.55).Conclusions. The use of patient navigators to create a network of services for PLWH who are unstably housed can improve housing stability and lead to improvements in HIV-related outcomes.

Introducing Patient Navigation to Trinidad and Tobago As a Method to Improve Public Cancer Care Delivery

Background and context: Despite significant public health care investment, Trinidad and Tobago (T&T) has poor cancer patient outcomes. For example, T&T has one of the highest breast cancer (BC) mortality rates in the Caribbean and the highest BC mortality/incidence ratio in the Americas. The BC 5-year survival rate for the period 1995-2007 was approximately 20%-30%, compared with 80% for the US. Many factors contribute to this disparity including healthcare administration challenges such as unavailability of drugs, long delays in securing appointments, loss of paper records and loss to follow-up. The introduction of a tailored patient navigation model is intended to address these challenges. Aim: To pilot the first, comprehensive public cancer patient navigation program with a focus on advanced breast cancer (ABC) patients in the Caribbean. Strategy/Tactics: Following ethical approval, focus groups will be held with hospital staff and the Ministry of Health to ascertain the most pressing patient needs and develop a clinical pathway that includes the navigator. Another focus group will be held with patients to determine needs. One full-time oncology nurse navigator will be assigned to an oncology unit where a physician and nurse liaison will be identified to provide support and supervision. A job description, scope of work, code of ethics, clinical pathway, consent forms, an oncology navigation software and instructions for use will be provided to the navigator. After patient consent, the navigator will provide tailored navigation services based on the predetermined scope of work. Services may include education, referrals to support groups and cancer treatment options, ensuring follow-up is complete, booking appointments and tracking all medical records electronically. The navigator will meet with the project coordinator biweekly to address challenges. The Patient Satisfaction with Cancer Care (PSCC) and the Patient Satisfaction with Navigator (PSN-1) questionnaires will also be administered as part of the process of validating of these metrics for this setting. Program/Policy process: Advocacy and support through personalized case management for cancer patients. Outcomes: We aim to enroll > 100 ABC patients. The following will be reported: (i) Number of ABC patients navigated; (ii) Average number of navigation appointments per patient and average time per appointment; (iii) Results of patient needs assessments; (iv) Validated PSCC and PSN-1 questionnaires; (v) Description of the clinical epidemiology of the cohort; (vi) Description of navigation role and code of ethics; (vii) Protocols for software use; (viii) Recommendations for implementation of a local training program; (ix) Evaluation of time to diagnostic resolution, time to treatment and follow-up care with comparisons to nonnavigated patients where possible.

Abstract 1637: The evolution of patient navigation research models to reduce breast cancer disparities: Case studies of patient navigation dissemination and implementation in Chicago

Abstract Background: Patient navigation for breast cancer seeks to diminish social, economic, cultural and medical system barriers to timely quality care. In the context of unmet patient needs, growing complexity of health care delivery systems, and significant local implementation challenges, patient navigation models must continue to evolve in order to advance context-appropriate implementation and sustainment of patient navigation into routine practice. We present five case studies in Chicago demonstrating evolving patient navigation models and in each case study, we explore challenges and opportunities related to advancing successful implementation of patient navigation interventions across the breast cancer care continuum. Methods: Case studies include: (1) a community-level adaptation of patient navigation in Chicago's Chinatown; (2) a community navigation program in Chicago's racially/ethnically diverse North Lawndale and Humboldt Park; (3) a county-wide dissemination of navigation in suburban DuPage County; (4) a state-wide scaling of a patient navigation model to the Illinois Department of Health and Family Services; and (5) a 4R patient navigation oncology model (4R = Right Information / Care / Patient / Time) grounded in systems engineering and design that leverages collaborative care plans and iterative examination and improvement of processes to address challenges of breast cancer care planning, team-based delivery and patient engagement. Results: Case studies in the evolution of patient navigation research programs show how identified gaps in care were remedied pragmatically in the course of each study. We show how patient navigation implementation efforts have been aided with evolving models incorporating the local implementation context, characteristics of program implementers, and structural, macro-level factors involving care delivery systems and public policy. Results highlight approaches for supporting organizational learning to enhance implementation and sustainability of navigation interventions; for furthering task clarification and coordination to optimize integration of patient navigation into cancer care delivery settings; and for tackling the impact of existing local, state, and national policy initiatives on patient navigation. Conclusions: Reducing breast cancer burden, especially among underserved populations, warrants adaptive, ongoing improvement of patient navigation models. Through iterative intervention development, evaluation, and refinement, patient navigation can move beyond serving as a temporary bandage for health systems fragmentation and toward an essential role in systems change for optimizing cancer care delivery. Citation Format: Melissa A. Simon, Laura S. Tom, Julia R. Trosman, Christine B. Weldon, Catherine A. O'Brian, Marcie C. Kirschner, XinQi Dong. The evolution of patient navigation research models to reduce breast cancer disparities: Case studies of patient navigation dissemination and implementation in Chicago [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1637.

Abstract A25: Community research navigators: The bridge to increasing ethnic minority participation in clinical research

Abstract The participation of underserved ethnic minorities in clinical research is critical to achieving progress in cancer control. Ethnic minority patient accrual in clinical trials is a formidable challenge that requires patient trust, commitment, and overcoming of barriers. Racial and ethnic minorities make up about 40% of the United States population, yet are not well represented in research studies. Less than 10% of all patients with cancer enrolled in clinical trials are minorities. Diverse participation may lead to more generalizable results for under-represented groups, more best practices for prevention and treatment to specific minority groups, increase in knowledge and awareness of disparities about cancer, and a more accurate reflection of the United States' increasingly diverse population. Although there is a proliferation of patient navigation programs to increase health care among the underserved, there is little known on its potential effects as a strategy to enhance minority clinical trial and biospecimen accrual. City of Hope has built a functional and sustainable program for addressing health inequity, which includes training a network of community research navigators (CRN) to address gaps in knowledge, medical mistrust, and access, and navigate participation and engagement of under-represented groups in research. The research navigator program draws from the patient navigation and promotora model and is a novel and innovative application to this approach. This approach has utility and applicability to address research participation barriers, including trust and referrals. It promises sustainability and cost effectiveness as trained CRNs can deliver the program. The Community Research Navigator (CRN) project enhances community advocates' capacity by training community health leaders/promotoras as community research navigators (CRN) to widen the dissemination of the clinical trial and research participation enrollment for increased ethnic minority participation in clinical trials and health-related research. CRNs attended a 1-day training on clinical trials and research. The training included educating and encouraging individuals to proactively think about and discuss clinical trial participation with their family, friends, and health care providers; disseminating information about specific research studies, targeting the African and Latino communities; and referring individuals to specific biospecimen, clinical trials, and population studies. In total, we trained and mentored a team of 14 CRNs. Participants were 24-66 years old; most were female (86%), Latino (69%), and single (43%). After participating in the training, participants were more likely to correctly define HIPAA (p=.040) and the types of clinical trials (p=.038). In addition, CRNs were more likely to encourage clinical research participation among their family after the training (p=0.034). Further, we measured confidence in various domains, including: increase in confidence in describing the purpose and process of clinical research (p=0.006); educating minority communities about clinical trials (p=0.045); and providing informational workshops/forums on clinical research (p=0.046). Participants had an increase in overall confidence (p=.033). Our findings demonstrate that the CRN strategy holds promise in increasing minority participation in cancer clinical trials. It is an innovative application of the extensively studied patient navigation approach that warrants research. Future research should focus on the CRN project as a cost-effective tool for enrollment and retention of ethnic minorities in cancer clinical trials and the potential of enhancing clinical trial understanding outcomes among participants. Citation Format: Marisela Garcia, Mayra Serrano, Alejandro Fernandez, Katty Nerio, Kimlin Ashing. Community research navigators: The bridge to increasing ethnic minority participation in clinical research [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A25.

2285 Patient navigation training: Community-engaged workforce development

OBJECTIVES/SPECIFIC AIMS: The goal of this initiative was to address this cancer health disparity in the Appalachian counties and help participants develop, implement and evaluate evidence-based “PN” that effectively and positively impacts patient and outcomes of the HealthyWomen Program. Following were the objectives of this training program: (1) To understand the broad range of roles and responsibilities associated with “PN”, including care coordination and case management, in the Pennsylvania HealthyWoman Program in Pennsylvania and the National Breast and Cervical Cancer Early Detection Program. (2) To identify and assess local resources and expertise for evidence-based “PN” in the HealthyWoman Program. (3) To utilize “PN” in association with public education and targeted outreach initiatives in the HealthyWoman Program. (4) To implement strategies to manage and evaluate “PN” for the HealthyWoman Program. METHODS/STUDY POPULATION: The series of PN training was held at Pittsburgh, Camp-Hill, Wilkes-Barre and Philadelphia during June 2017. In total, 86 participants attended the training program at one of these 4 locations. Attendees represented organizations that provided breast, cervical and colorectal cancer outreach, screening and treatment. The participants of the training were solicited by regional program managers of the HealthyWoman Program of the PA Department of Health. The Harold Freeman model for patient navigation model was used to train the participants on the concepts of patient navigation. The training was built upon the Health Belief Model and Chronic Care Model, which defined the specific program constructs. The curriculum covered 2 important aspects, that is, clinical knowledge related to breast and cervical cancer along with aspects of patient navigation. Participants represented small, and large academic institutions/health care systems, cancer centers, federally qualified health centers, health departments as well as community-based screening programs and organizations. RESULTS/ANTICIPATED RESULTS: A total of 86 participants were trained; 78% had formal education and training in health-related field. In total, 62% of the participants had previous experience of patient navigation; 42% had training in social service related field and 50% had prior experience as community health worker. The demographic details reflected that majority of the participants (94%) were female. Most of the participants (30%) belonged to 50–64 years of age group followed by 30–39 years (23%) and 40–49 years (22%) of age group, respectively. As part of ethnic distribution, 70% of the participants were White Americans followed by Black/African Americans (17%). Furthermore, association of previous training in health and social service field with and without experience as a community health worker (n=84) and Navigator (n=86) was also analyzed. Among the participants, 44% had both community health worker experiences along with a prior training in social service related field whereas 42% of the respondents only had prior social service related training. This association of previous training in social service related field and prior community health worker experience was statistically significant with a p value of <0.05. Additionally, 81% of the participants who had previous experience in health-related training also possessed the prior experience as community health worker. Also, 81% of the participants who had previous training in health-related field also had a prior experience of patient navigation. In all, 38% of the participants who had a previous experience in social service field also had a prior experience of patient navigation. DISCUSSION/SIGNIFICANCE OF IMPACT: The training program established a pool of patient navigators which will contribute towards reducing the cancer health disparity in the Appalachian region of Pennsylvania. The participants reflected a wide diversity in the navigators’ backgrounds and differences across programs in their choices of patient navigators. It is important to consider this diversity when designing curricula materials and the methods of delivery in a patient navigation training program. As PN training programs are developed and implemented, further data is needed to guide practitioners and administrators in their efforts to include separate curriculum and materials for experienced and lay navigators. In addition, it is also important to assess the role and involvement of patient navigators in research and clinical trials. In total, 82% of the participants when asked agreed to be contacted for participation in research studies. Specific curriculum which includes research could be designed for further development of patient navigators. PN training and implementation knowledge is critical to the development of standards and best practices in this emergent area of cancer care.

Paediatric patient navigation models of care in Canada: An environmental scan.

(1) To provide other organizations with useful information when implementing paediatric navigation programs and (2) to inform the implementation of a navigation care centre in New Brunswick for children with complex health conditions. This environmental scan consisted of a literature review of published and grey literature for paediatric patient navigation programs across Canada. Additional programs were found following discussions with program coordinators and navigators. Interviews were conducted with key staff from each program and included questions related to patient condition; target population and location; method delivery; navigator background; and navigator roles. Data analysis included analysis of interviews and identification of common themes across the different programs. We interviewed staff from 19 paediatric navigation programs across Canada. Programs varied across a number of different themes, including: condition and disease type, program location (e.g., hospital or clinic), navigator background (e.g., registered nurse or peer/lay navigator) and method of delivery (e.g., phone or face-to-face). Overall, navigator roles are similar across all programs, including advocacy, education, support and assistance in accessing resources from both within and outside the health care system. This scan offers a road map of Canadian paediatric navigation programs. Knowledge learned from this scan will inform stakeholders who are either involved in the delivery of paediatric patient navigation programs or planning to implement such a program. Specifically, our scan informed the development of a navigation centre for children with complex health conditions in New Brunswick.

Two Innovative Cancer Care Programs Have Potential to Reduce Utilization and Spending.

Cancer patients often present to the emergency department (ED) and hospital for symptom management, but many of these visits are avoidable and costly. We assessed the impact of 2 Health Care Innovation Awards that used an oncology medical home model [Community Oncology Medical Home (COME HOME)] or patient navigation model [Patient Care Connect Program (PCCP)] on utilization and spending. Participants in COME HOME and PCCP models were matched to similar comparators using propensity scores. We analyzed utilization and spending outcomes using Medicare fee-for-service claims with unadjusted and adjusted difference-in-differences models. In the adjusted models, both COME HOME and PCCP were associated with fewer ED visits than a comparison group (15 and 22 per 1000 patients/quarter, respectively; P<0.01). In addition, COME HOME had lower spending ($675 per patient/quarter; P<0.01), and PCCP had fewer hospitalizations (11 per 1000 patients/quarter; P<0.05), relative to the comparison group. Among patients undergoing chemotherapy, fewer COME HOME and PCCP patients had ED visits (18 and 28 per 1000 patients/quarter, respectively; P<0.01) and fewer PCCP patients had hospitalizations (13 per 1000 patients/quarter; P<0.05), than comparison patients. The oncology medical home and patient navigator programs both showed reductions in spending or utilization. Adoption of such programs holds promise for improving cancer care.

The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation

BackgroundTotal knee arthroplasty (TKA) is the most frequently performed joint replacement surgery in North America. Patient perspectives on TKA have been investigated in various ways, including finding as many as 20% of TKA patients are dissatisfied with their surgical outcomes. Understanding the patient experience with TKA broadly and in relation to patient satisfaction is a key gap in existing literature.MethodsWe report on the qualitative component of a mixed methods prospective cohort study examining patient experience and satisfaction post-TKA for adults in British Columbia, Canada. Data collection consisted of 45 in-depth interviews about individuals’ knee surgery experiences conducted eight months after surgery. Analysis consisted of thematic coding by multiple coders.ResultsParticipants’ descriptions of their TKA experiences were primarily concerned with support, or the provision of aid and assistance. Support was insufficient when their expectations of support were not met; unmet support expectations led to an overall negative TKA experience. Support operated in three key domains: (1) informational support, (2) clinical support, and (3) personal support. Key sources of informational and clinical support included pre-optimisation clinics, surgeons, and physiotherapists. Key topics for informational support included pain, pain management, and recovery trajectories. Personal support was provided by family, friends, other TKA patients, employers, and themselves.ConclusionsPatient needs and expectations for support are shaped both before and after TKA surgery. Patients with an overall positive TKA experience had improvement in their knee pain, stiffness or functioning post-TKA, had their major expectations and needs for support met during their TKA recovery, and believed that any significant future expectations or needs for ongoing support would be adequately met. In contrast, patients with an overall negative TKA experience had at least one major expectation or need for support not met during their TKA recovery, even in cases where they had good TKA outcomes. Suggested interventions to improve the experience of persons receiving TKA include an expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients’ TKA experience.

Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending.

Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) and fewer hospitalizations in the last thirty days of life (fifty-seven and forty per 1,000 people, respectively). The patient navigation model was also associated with fewer emergency department visits in the last thirty days of life and increased hospice enrollment in the last two weeks of life. These promising results can inform new initiatives for cancer patients, such as the CMS Oncology Care Model.