title: Clinical case management and navigation for colonoscopy screening in an academic medical center.
abstract: BACKGROUND
  One of 5 nationally funded Centers for Disease Control and Prevention Colorectal Cancer (CRC) Screening Demonstration Programs, Project SCOPE, was conducted at an academic medical center and provided colonoscopy screening at no cost to underserved minority patients from local community health centers.
  
  
  METHODS
  Established barriers to CRC screening (eg, financial, language, transportation) among the target population were addressed through clinical coordination of care by key project staff. The use of a clinician with a patient navigator allowed for the performance of precolonoscopy "telephone visits" instead of office visits to the gastroenterologist in virtually all patients. The clinician elicited information relevant to making screening decisions (eg, past medical and surgical history, focused review of systems, medication/supplement use, CRC screening history). The patient navigator reduced barriers, including, but not limited to, scheduling, transportation, and physical navigation of the medical center on the day of colonoscopy.
  
  
  RESULTS
  Preprogram preparation was vital in laying groundwork for the project, yet enhancements to the program were ongoing throughout the screening period. Detailed referral forms from primary care physicians, coupled with information obtained during telephone interviews, facilitated high colonoscopy completion rates and excellent patient satisfaction. Similarly valuable was the employment of a bilingual patient navigator, who provided practical and emotional patient support.
  
  
  CONCLUSIONS
  Academic medical centers can be efficient models for providing CRC screening to disadvantaged populations. Coordination of care by a preventive medicine department, directing the recruitment, scheduling, prescreening education, and the evaluation and preparation of target populations had an overall positive effect on CRC screening with colonoscopy among patients from a community health center.
authors.affiliation: Northport Veterans Affairs Medical Center, Northport, New York 11768, USA. Mary.Cavanagh2@va.gov
authors.forename: Mary F
authors.initials: MF
authors.lastname: Cavanagh
authors.forename: Dorothy S
authors.initials: DS
authors.lastname: Lane
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Messina
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Anderson
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration; D019090:Case Management / Q000191:economics / Q000458:organization & administration; D003113:Colonoscopy / Q000191:economics / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration*; D011203:Poverty; D014481:United States
keywords: academic medical center; colonoscopy; colorectal cancer; colorectal cancer screening; health centers