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Dissemination of patient navigation programs across the United States
Nancy Hedlund1, Betsy C Risendal, Heather Pauls
1University of Illinois at Chicago (Mss Hedlund and Pauls and Drs Stiehl and Calhoun); Colorado School of Public Health, University of Colorado Denver (Dr Risendal and Ms Valverde), Denver Health, Denver, Colorado (Dr Whitley); and American Cancer Society, Atlanta, Georgia (Ms Esparza).
Objective:
To use diffusion and dissemination frameworks to describe how indicators of economic and health care disparity affect the location and type of patient navigation programs.
Methods:
A cross-sectional national Web-based survey conducted during 2009-2010 with support from 65 separate national and regional stakeholder organizations.
Participants:
A total of 1116 self-identified patient navigators across the United States.
Main Outcome Measure:
The location and characteristics of patient navigation programs according to economic and health care disparity indicators.
Results:
Patient navigation programs appear to be geographically dispersed across the United States. Program differences were observed in navigator type, population served, and setting by poverty level. Programs in high-poverty versus low-poverty areas were more likely to use lay navigators (P < .001) and to be located in community health centers and agencies with religious affiliations (50.6 vs 36.4%, and 21.5% vs 16.7%. respectively; P ≤ 0.01).
Conclusion(S):
Results suggest that navigation programs have spread beyond initial target inception areas and also serve as a potentially important resource in communities with higher levels of poverty and/or relatively low access to care. In addition, while nurse navigators have emerged as a significant component of the patient navigation workforce, lay health navigators serve a vital role in underserved communities. Other factors from dissemination frameworks may influence the spread of navigation and provide useful insights to support the dissemination of programs to areas of high need.
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