ohio patient navigator research program (opnrp)
DESCRIPTION
Ohio Patient Navigator Research Program (OPNRP). Electra D. Paskett, Ph.D. April 2007. Goal. 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. - PowerPoint PPT PresentationTRANSCRIPT
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Ohio Patient Navigator Research Program (OPNRP)
Electra D. Paskett, Ph.D.
April 2007
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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
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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
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Cancer Care Barriers
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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
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Navigator Role
3
Patient Navigator Possible Roles
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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
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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
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•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
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OhioState Ranking
Estimated New Cancer: 2004
All Cases 7th
Breast 6th
Cervical 10th Colorectal 6th
American Cancer Society, 2004
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OhioState Ranking
Estimated Cancer Mortality: 2004
All Sites 7th
Breast 6th
Colorectal 6th
American Cancer Society, 2004
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Theoretical Framework
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Patient And Clinic Level Theories
Patient - Social Support/Network - Health Belief Model
Clinic - Innovation and Organizational Change - Physician and Organizational Readiness For Change
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• Develop Community Advisory Board
• Select Clinic Sites
• Hire and Train Staff
Specific Aim 1
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• Organize community advisory board • Clinical site selection• Staff hired and trained
Start-up Activities
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Staff
• Program Manager
• 3 Research Interviewers
• 3 Patient Navigators
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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
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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
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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
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• 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
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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
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Study Design
Patient Navigation
Education Only
Participating Clinics
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All Populations
2 Intervention & 2 Control
Minority/ Underserved
2 Intervention & 2 Control
Federally Funded
2 Intervention & 2 Control
Clinic Type
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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
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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
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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
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• 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
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• Baseline Assessment: Organizational history and current practices
• Follow-up Assessment: How was the patient navigation program received, implemented, and accepted within each clinic
EvaluationClinics
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• Program: operational, specific components
• Savings: change in cost attributable to the program
• Effectiveness: cost of the intervention and calculation of net cost
EvaluationCost
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•Continue process in 8 clinics•Bring CNHC clinics on line•Translate materials into Spanish•Continue to refine procedures•Monitor process•Collect data
Next Steps
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• Partners in Cleveland and Cincinnati
• National Partners
•Policy Implications
Dissemination: Future Plans