title: A multilevel intervention to promote colorectal cancer screening among community health center patients: results of a pilot study.
abstract: BACKGROUND
  Colorectal cancer screening rates are low among poor and disadvantaged patients. Patient navigation has been shown to increase breast and cervical cancer screening rates, but few studies have looked at the potential of patient navigation to increase colorectal cancer screening rates.
  
  
  METHODS
  The objective was to determine the feasibility and effectiveness of a patient navigator-based intervention to increase colorectal cancer screening rates in community health centers. Patients at the intervention health center who had not been screened for colorectal cancer and were designated as "appropriate for outreach" by their primary care providers received a letter from their provider about the need to be screened and a brochure about colorectal cancer screening. Patient navigators then called patients to discuss screening and to assist patients in obtaining screening. Patients at a demographically similar control health center received usual care.
  
  
  RESULTS
  Thirty-one percent of intervention patients were screened at six months, versus nine percent of control patients (p < .001).
  
  
  CONCLUSIONS
  A patient navigator-based intervention, in combination with a letter from the patient's primary care provider, was associated with an increased rate of colorectal cancer screening at one health center as compared to a demographically similar control health center. Our study adds to an emerging literature supporting the use of patient navigators to increase colorectal cancer screening in diverse populations served by urban health centers.
authors.affiliation: Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA. karen.lasser@bmc.org.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lasser
authors.forename: Jennifer
authors.initials: J
authors.lastname: Murillo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Medlin
authors.forename: Sandra
authors.initials: S
authors.lastname: Lisboa
authors.forename: Lisa
authors.initials: L
authors.lastname: Valley-Shah
authors.forename: Robert H
authors.initials: RH
authors.lastname: Fletcher
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D003151:Community Health Centers; D003159:Community-Institutional Relations; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010865:Pilot Projects; D011204:Poverty Areas; D011320:Primary Health Care / Q000379:methods*; D012923:Social Class