Assessing the implementation of a patient navigation intervention for colonoscopy screening

Area of Science:

• Public Health
• Health Services Research
• Cancer Prevention

Background:

• The New Hampshire Colorectal Cancer Screening Program (NHCRCSP) utilized a patient navigation (PN) program to aid low-income individuals in completing colonoscopy screening.
• The PN intervention was delivered via telephone, adhering to a structured six-topic protocol.
• The RE-AIM framework was employed to evaluate implementation processes and scalability.

Purpose of the Study:

• To evaluate the implementation processes and potential scalability of the NHCRCSP's patient navigation program.
• To assess the effectiveness of the PN intervention in facilitating colonoscopy completion among low-income patients.

Main Methods:

• A mixed-methods evaluation incorporating a quasi-experimental, retrospective comparison group study.
• Analysis of NHCRCSP program data for 443 navigated patients (July 2012–September 2013).
• In-depth case study including document review, navigator observations, and interviews with 27 stakeholders.

Main Results:

• The program achieved state-wide reach, successfully recruiting eligible low-income patients.
• High effectiveness was demonstrated with 97.3% of navigated patients completing colonoscopy, zero no-shows, and 0.7% late cancellations.
• Key implementation factors included consistent funding, a strong infrastructure, partnerships, nurse navigators, a clinical champion, and a real-time data system.

Conclusions:

• The PN program's success was supported by funding, use of registered nurses, strong partnerships, protocol fidelity, adequate intervention dose, and a real-time data system.
• Consistent funding from the CDC and robust partnerships were crucial for program maintenance.
• Further research is recommended to explore the scalability of this patient navigation model to other settings.