title: The longitudinal impact of patient navigation on equity in colorectal cancer screening in a large primary care network.
abstract: BACKGROUND
  The long-term effects of interventions to improve colorectal (CRC) screening in vulnerable populations are uncertain. The authors evaluated the impact of patient navigation (PN) on the equity of CRC prevention over a 5-year period.
  
  
  METHODS
  A culturally tailored CRC screening PN program was implemented in 1 community health center (CHC) in 2007. In a primary care network, CRC screening rates from 2006 to 2010 among eligible patients from the CHC with PN were compared with the rates from other practices without PN. Multivariable logistic regression models for repeated measures were used to assess differences over time.
  
  
  RESULTS
  Differences in CRC screening rates diminished among patients at the CHC with PN and at other practices between 2006 (49.2% vs 62.5%, respectively; P < .001) and 2010 (69.2% vs 73.6%, respectively; P < .001). The adjusted rate of increase over time was higher at the CHC versus other practices (5% vs 3.4% per year; P < .001). Among Latino patients at the CHC compared with other practices, lower CRC screening rates in 2006 (47.5% vs 52.1%, respectively; P = .02) were higher by 2010 (73.5% vs 67.3%, respectively; P < .001). Similar CRC screening rates among non-English speakers at the CHC and at other practices in 2006 (44.3% vs 44.7%, respectively; P = .79) were higher at the CHC by 2010 (70.6% vs 58.6%, respectively; P < .001). Adjusted screening rates increased more over time for Latino and non-English speakers at the CHC compared with other practices (both P < .001).
  
  
  CONCLUSIONS
  A PN program increased CRC screening rates in a CHC and improved equity in vulnerable patients. Long-term funding of PN programs has the potential to reduce cancer screening disparities.
authors.affiliation: Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, Massachusetts; General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
authors.forename: Lenny
authors.initials: L
authors.lastname: López
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ashburner
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Green
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D003144:Communication Barriers; D003151:Community Health Centers / Q000592:standards / Q000639:trends; D003466:Cultural Characteristics; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D057220:Health Literacy; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D019303:Multilingualism; D062526:Patient Navigation / Q000379:methods / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000592:standards / Q000639:trends; D015397:Program Evaluation; D013997:Time Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
keywords: colorectal cancer screening; disparities; patient navigation; vulnerable populations