title: Reach, usage, and effectiveness of a Medicaid patient navigator intervention to increase colorectal cancer screening, Cape Fear, North Carolina, 2011.
abstract: BACKGROUND
  Screening for colorectal cancer can reduce incidence and death, but screening is underused, especially among vulnerable groups such as Medicaid patients. Effective interventions are needed to increase screening frequency. Our study consisted of a controlled trial of an intervention designed to improve colorectal cancer screening among Medicaid patients in North Carolina.
  
  
  METHODS
  The intervention included a mailed screening reminder letter and decision aid followed by telephone support from an offsite, Medicaid-based, patient navigator. The study included 12 clinical practices, 6 as intervention practices and 6 as matched controls. Eligible patients were aged 50 years or older, covered by Medicaid, and identified from Medicaid claims data as not current with colorectal cancer screening recommendations. We reviewed Medicaid claims data at 6 months and conducted multivariate logistic regression to compare participant screening in intervention practices with participants in control practices. We controlled for sociodemographic characteristics.
  
  
  RESULTS
  Most of the sample was black (53.1%) and female (57.2%); the average age was 56.5 years. On the basis of Medicaid claims, 9.2% of intervention participants (n = 22/240) had had a colorectal cancer screening at the 6-month review, compared with 7.5% of control patients (n = 13/174). The adjusted odds ratio when controlling for age, comorbidities, race, sex, and continuous Medicaid eligibility was 1.44 (95% confidence interval, 0.68-3.06). The patient navigator reached 44 participants (27.6%).
  
  
  CONCLUSIONS
  The intervention had limited reach and little effect after 6 months on the number of participants screened. Higher-intensity interventions, such as use of practice-based navigators, may be needed to reach and improve screening rates in vulnerable populations.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, 725 Martin Luther King Jr Blvd, CB# 7590, Chapel Hill, NC 27599-7590, USA. lucia@unc.edu
authors.forename: Lucia A
authors.initials: LA
authors.lastname: Leone
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Reuland
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Lewis
authors.forename: Mary
authors.initials: M
authors.lastname: Ingle
authors.forename: Brian
authors.initials: B
authors.lastname: Erman
authors.forename: Tyana J
authors.initials: TJ
authors.lastname: Summers
authors.forename: C Annette
authors.initials: CA
authors.lastname: Dubard
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000592:standards* / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D062526:Patient Navigation / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013689:Telephone; D014481:United States