Patient Navigation for Comprehensive Cancer Screening in High-Risk Patients Using a Population-Based Health Information Technology System: A Randomized Clinical Trial.
OBJECTIVE
Patient navigation (PN) to improve cancer screening in low-income and racial/ethnic minority populations usually focuses on navigating for single cancers in community health center settings.


OBJECTIVE
We evaluated PN for breast, cervical, and colorectal cancer screening using a population-based information technology (IT) system within a primary care network.


METHODS
Randomized clinical trial conducted from April 2014 to December 2014 in 18 practices in an academic primary care network. All patients eligible and overdue for cancer screening were identified and managed using a population-based IT system. Those at high risk for nonadherence with completing screening were identified using an electronic algorithm (language spoken, number of overdue tests, no-show visit history), and randomized to a PN intervention (n = 792) or usual care (n = 820). Navigators used the IT system to track patients, contact them, and provide intense outreach to help them complete cancer screening.


METHODS
Mean cancer screening test completion rate over 8-month trial for each eligible patient, with all overdue cancer screening tests combined using linear regression models. Secondary outcomes included the proportion of patients completing any and each overdue cancer screening test.


RESULTS
Among 1612 patients (673 men and 975 women; median age, 57 years), baseline patient characteristics were similar among randomized groups. Of 792 intervention patients, patient navigators were unable to reach 151 (19%), deferred 246 (38%) (eg, patient declined, competing comorbidity), and navigated 202 (32%). The mean proportion of patients who were up to date with screening among all overdue screening examinations was higher in the intervention vs the control group for all cancers combined (10.2% vs 6.8%; 95% CI [for the difference], 1.5%-5.2%; P < .001), and for breast (14.7% vs 11.0%; 95% CI, 0.2%-7.3%; P = .04), cervical (11.1% vs 5.7%; 95% CI, 0.8%-5.2%; P = .002), and colon (7.6% vs 4.6%; 95% CI, 0.8%-5.2%; P = .01) cancer compared with control. The proportion of overdue patients who completed any cancer screening during follow-up was higher in the intervention group (25.5% vs 17.0%; 95% CI, 4.7%-12.7%; P < .001). The intervention group had more patients completing screening for breast (23.4% vs 16.6%; 95% CI, 1.8%-12.0%; P = .009), cervical (14.4% vs 8.6%; 95% CI, 1.6%-10.5%; P = .007), and colorectal (13.7% vs 7.0%; 95% CI, 3.2%-10.4%; P < .001) cancer.


CONCLUSIONS
Patient navigation as part of a population-based IT system significantly increased screening rates for breast, cervical, and colorectal cancer in patients at high risk for nonadherence with testing. Integrating patient navigation into population health management activities for low-income and racial/ethnic minority patients might improve equity of cancer care.


BACKGROUND
clinicaltrials.gov Identifier: NCT02553538.
Massachusetts General Hospital, Division of General Medicine, Boston2Massachusetts General Hospital, Chelsea HealthCare Center, Chelsea3Harvard Medical School, Boston, Massachusetts.
Sanja
S
Percac-Lima
Massachusetts General Hospital, Division of General Medicine, Boston3Harvard Medical School, Boston, Massachusetts.
Jeffrey M
JM
Ashburner
Harvard Medical School, Boston, Massachusetts4Massachusetts General Hospital, Laboratory of Computer Sciences, Boston.
Adrian H
AH
Zai
Massachusetts General Hospital, Division of General Medicine, Boston3Harvard Medical School, Boston, Massachusetts.
Yuchiao
Y
Chang
Massachusetts General Hospital, Chelsea HealthCare Center, Chelsea.
Sarah A
SA
Oo
Massachusetts General Hospital, Chelsea HealthCare Center, Chelsea.
Erica
E
Guimaraes
Massachusetts General Hospital, Division of General Medicine, Boston3Harvard Medical School, Boston, Massachusetts.
Steven J
SJ
Atlas
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008490:Medical Informatics / Q000379:methods*; D008875:Middle Aged; D054525:Minority Health / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data; D062526:Patient Navigation / Q000379:methods / Q000458:organization & administration; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control