Ohio Patient Navigator Research Program (OPNRP)

1. Ohio Patient Navigator Research Program (OPNRP) Electra D. Paskett, Ph.D. April 2007

2. Goal To develop and evaluate a program to facilitate timely access to quality, standard cancer care for persons diagnosed with breast, cervical, and colorectal cancer in a culturally sensitive manner.

3. Patient Navigator Background Delivery Discovery Development Beneficial procedures for cancer prevention, early detection, diagnosis, and treatment For All Americans Critical Disconnect results in cancer health disparities There is a critical disconnect between cancer discoveries and cancer care delivery toall American people.

4. Cancer Care Barriers

5. General Framework of Patient Navigation Program PATIENT NAVIGATION • Abnormal finding/diagnosis to resolution • Eliminate critical delivery gap for populations experiencing disparities • Test feasibility of Patient Navigation intervention concept • Identify, test, and measure delivery improvement interventions that use Patient Navigators REHABILITATION OUTREACH Resolution Abnormal Finding Conclude Navigation Initial Contact Abnormal results/ Diagnosis Diagnosis Treatment Survivorship

6. Navigator Role Patient Navigator Possible Roles 3

8. Cancer Sites To Be Examined

9. Target Populations Black Hispanic AI/AN Underserved

10. Columbus, Ohio • Total population: 711,470 • Racial composition: 68% White 25% African American 3% Asian <1% Native American <1% Pacific Islander 3% Two or more races • Hispanic or Latino of any race: 3% • 2003 poverty rate: 16.5%

11. Ohio State Ranking Estimated New Cancer: 2004 All Cases 7th Breast 6th Cervical 10th Colorectal 6th American Cancer Society, 2004

12. Ohio State Ranking Estimated Cancer Mortality: 2004 All Sites 7th Breast 6th Colorectal 6th American Cancer Society, 2004

13. Theoretical Framework

14. Patient And Clinic Level Theories Patient - Social Support/Network - Health Belief Model Clinic - Innovation and Organizational Change - Physician and Organizational Readiness For Change

15. Specific Aim 1 • Develop Community Advisory Board • Select Clinic Sites • Hire and Train Staff

16. Start-up Activities • Organize community advisory board • Clinical site selection • Staff hired and trained

17. Staff • Program Manager • 3 Research Interviewers • 3 Patient Navigators

18. Patient Navigator Training • National Training • Local ACS networking, attended meetings, participated in conference calls and one on one interaction with navigators • Toured local clinics and hospitals to identify contact people and resources • Meeting with clinical psychologists and health educators • Ongoing training and weekly meetings w/ Melissa • Attended relevant seminars • Systematically researched and reviewed existing patient educational materials • Visits to chemo suites, observed procedures • Designed doctor – patient communication handbook

19. Specific Aim 2 • Develop the OPNRP through the work of a consortium of institutions including: • The Ohio State University Comprehensive Cancer Center and James Cancer Hospital • Columbus Neighborhood Health Centers • The Ohio Division of the American Cancer Society • The Ohio Commission on Minority Health

20. Ohio Patient Navigator Research Program Community Advisory Board Diversity Enhancement Program Holland Ohio Commission on Minority Health Boyce MEMBERS ExpertsOSUCCC Breast: Shapiro Cervical: O’Malley Colorectal: Saab The Ohio State University OSUCCC Paskett – Principal Investigator Family Medicine Post – Co Principal Investigator EVALUATION / RESEARCH CORE Murray - Leader Pirie - Process Caswell - Economic McAlearney - Clinic Level Katz – Health Literacy Kelly – Patient Directed Alfano – Quality of Life ADMINISTRATIVE CORE Tatum - Project DirectorDeGraffinreid - Data & QA Supervisor Cluxton – Program Manager Hennigan – Research Associate Ball – Database Manager PATIENT NAVIGATORS Katz – Co Investigator Hicks – Navigator Supervisor Broadnax - Patient Navigator Teba - Patient Navigator Silva - Patient Navigator OSU Primary Care Network Family Medicine Welker – Collaborator General Internal Medicine Thomas - Co Investigator Columbus Neighborhood Health Centers Van Putten- Collaborator

21. Specific Aims 3-5 • Implement and evaluate the OPNRP in 12 • primary care clinics using a group randomized, • controlled design • Conduct a process evaluation to assess the • barriers to implementation, patient satisfaction, • clinic perceptions of the OPNRP • Conduct a cost-effectiveness evaluation of OPNRP

22. OSU Primary Care Network Family Medicine (8) - 17,115 patients 51+ years- 66% female- 31% minority General Internal Medicine (3) - 6,991 patients 51+ years- 66% female- 11% minority Neighborhood Health Centers (5) - 2,400 patients 55+ years - 63% females - 53% minority

23. Study Design Patient Navigation Participating Clinics Education Only

24. Clinic Type

25. Estimated Patients Enrolled

26. Participating clinic sites OSU Primary Care Network - 8 • OSU Family Practice at Worthington • OSU Family Practice at Gahanna • OSU Family Practice at University Hospital – East • OSU Family Practice on South High • OSU Family Practice at Upper Arlington • Rardin Family Practice • OSU Internal Medicine at Stoneridge • OSU Internal Medicine at University Hospitals – Cramblett Columbus Neighborhood Health Centers - 4 • Hilltop Health Center • John Maloney South Side Health Center • St. Stephen’s Health Center • East Central Health Center

27. Evaluation Primary Outcome Assess the effect of the OPNRP on reducing time from a patient’s abnormal screening result to: - Diagnosis/Resolution- Start of treatment- Completion of treatment

28. Evaluation Process • What is working well and not so well? • Who does not use the navigators, who uses and continues • to use navigators and why and what types of activities does • the navigator perform? • What features of the OPNRP are viewed as most positive • or helpful by patients, staff, and healthcare providers? • Does OPNRP succeed in changing intermediate outcomes • such as patient knowledge about key resources, feeling of • being supported etc?

29. Evaluation Clinics • Baseline Assessment: Organizational history and current practices • Follow-up Assessment: How was the patient navigation program received, implemented, and accepted within each clinic

30. Evaluation Cost • Program: operational, specific components • Savings: change in cost attributable to the program • Effectiveness: cost of the intervention and calculation of net cost

31. Next Steps • Continue process in 8 clinics • Bring CNHC clinics on line • Translate materials into Spanish • Continue to refine procedures • Monitor process • Collect data

32. Dissemination: Future Plans • Partners in Cleveland and Cincinnati • National Partners • Policy Implications