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Systems navigators and integration (e.g., Patient Navigators)

Health Factors: Access to Care
Decision Makers: Community Organizations, Healthcare Organizations
Evidence Rating: Scientifically Supported
Population Reach: 100% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Patient navigators provide culturally sensitive assistance and care-coordination, guiding patients through available medical, insurance, and social support systems. These programs seek to reduce racial, ethnic, and economic disparities in access to care and disease outcomes (Vargas 2008). 

Expected Beneficial Outcomes

Increased use of preventive services
Increased cancer screening
Improved birth outcomes
Improved maternal health

Evidence of Effectiveness

There is strong evidence that patient navigator programs improve cancer screening, especially for breast cancer (Phillips 2010, Robinson-White 2010). Additional evidence is needed to confirm effects for programs focused on other health outcomes.

Patient navigators improve breast cancer screening, diagnosis, and treatment (Robinson-White 2010), and can also increase screening for colorectal cancer (Fisher 2007). By increasing screening, such programs have the potential to reduce racial disparities in early detection (Robinson-White 2010, Phillips 2010, Fisher 2007).

Patient navigator programs to improve prenatal care are recommended (CDC-Reach, NACCHO-PNP), but have not been rigorously evaluated. Such programs may help women navigate the Medicaid system, find managed care and a provider, and obtain other services such food and transportation assistance (Payne 2011, NACCHO-PNP).

Implementation Examples

United States

Patient navigator programs vary widely across the country. Such programs are more available in some places than others; a few examples follow. Perinatal navigators for at risk women are funded by Maryland (MD 2012) and prenatal navigators by the CDC REACH US program at Virginia Commonwealth University (CDC-Reach). Pregnancy Partners in Clark County WA assists low income women in accessing prenatal care during the first trimester (Payne 2011). The American Cancer Society provides guidance through a Patient Navigator Program (ACS), and as of February 2012 there are 17 pilot project sites sponsored by the National Cancer Institute's Patient Navigation Program (NCI-PNP). Section 3510 of the Affordable Care Act authorizes but does not appropriate funding for Patient Navigation Programs.

Wisconsin

The Center for Patient Partnerships at the University of Wisconsin-Madison offers certificates in Consumer Health Advocacy (UW-CPP).

Implementation Resources

KCP-CPPNW 2009 - Kansas Cancer Partnership (KCP). Cancer patient navigation program toolkit (CPPNW). 2009. Accessed on June 19, 2012
Webpage: http://www.cancerkansas.org/toolkit.htm

Citations - Description

Vargas 2008 - Vargas RB, Ryan GW, Jackson CA, Freeman HP. Characteristics of the original patient navigation programs to reduce disparities in the diagnosis and treatment of breast cancer. Cancer. 2008;113(2):426-33. Accessed on March 24, 2013
Webpage: http://onlinelibrary.wiley.com/doi/10.1002/cncr.23547/pdf

Citations - Evidence

CDC-Reach - Centers for Disease Control and Prevention (CDC). Reach US Virginia Commonwealth University. Accessed on June 20, 2012
Webpage: http://www.cdc.gov/reach/communities/pdf/Richmond_VA2.pdf
Fisher 2007 - Fisher TL, Burnet DL, Huang ES, Chin MH CK. Cultural leverage: Interventions using culture to narrow racial disparities of health care. Medical Care Research and Review. 2007;64(5 Suppl):243S-282S. Accessed on June 20, 2012
Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505343/pdf/nihms49597.pdf
NACCHO-PNP - National Association of County & City Health Officials (NACCHO). Patient navigator program. Accessed on June 20, 2012
Webpage: http://www.naccho.org/topics/modelpractices/database/practice.cfm?practiceID=836
Payne 2011 - Payne M, Storey M, Sanders D. Pregnancy partners: A patient navigator system to improve early prenatal care. Washington State Journal of Public Health Practice. 2011;4(S1). Accessed on June 23, 2012
Webpage: http://www.wsphajournal.org/V4S1/V4S1Payne1.pdf
Phillips 2010 - Phillips CE, Rothstein JD, Beaver K, et al. Patient navigation to increase mammography screening among inner city women. Journal of General Internal Medicine. 2010;26(2):123-9. Accessed on June 20, 2012
Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019333/pdf/11606_2010_Article_1527.pdf
Robinson-White 2010* - Robinson-White S, Conroy B, Slavish KH, Rosenzweig M. Patient navigation in breast cancer: A systematic review. Cancer Nursing. 2010;33(2):127-40. Accessed on June 19, 2012
Webpage: http://journals.lww.com/cancernursingonline/Abstract/2010/03000/Patient_Navigation_in_Breast_Cancer__A_Systematic.7.aspx

Citations - Implementation Examples

CDC-Reach - Centers for Disease Control and Prevention (CDC). Reach US Virginia Commonwealth University. Accessed on June 20, 2012
Webpage: http://www.cdc.gov/reach/communities/pdf/Richmond_VA2.pdf
MD 2012 - Maryland StateStat. 14. Reduce infant mortality in Maryland by 10% by 2012. Accessed on June 23, 2012
Webpage: http://www.statestat.maryland.gov/gduinfant.asp
NCI-PNP - Center to Reduce Cancer Health Disparities (CRCHD). PNP project listing. National Cancer Institute (NCI). Accessed on June 18, 2012
Webpage: http://crchd.cancer.gov/pnp/pnp-project-listing.html
Payne 2011 - Payne M, Storey M, Sanders D. Pregnancy partners: A patient navigator system to improve early prenatal care. Washington State Journal of Public Health Practice. 2011;4(S1). Accessed on June 23, 2012
Webpage: http://www.wsphajournal.org/V4S1/V4S1Payne1.pdf
UW-CPP - Center for Patient Partnerships (CPP). Overview & choosing a certificate. Accessed on June 20, 2012
Webpage: http://www.patientpartnerships.org/education/opportunities/certificate-programs/overview-choosing-a-certificate/

* Journal subscription may be required for access.

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Evidence Rating

Level of effectiveness based on a scan of academic literature and key recommendations of leading organizations.

  • Scientifically Supported Numerous studies or systematic review(s) with positive results
  • Some Evidence Research suggests positive impacts; further study may be warranted
  • Expert Opinion Recommended by credible groups*; research evidence limited
  • Insufficient Evidence Evidence limited or unavailable; further study warranted
  • Mixed Evidence Evidence mixed; further study warranted
  • Evidence of Ineffectiveness Research consistently shows program is detrimental or has no effect

Although many policies and programs are recommended by credible groups, we apply the rating ‘expert opinion’ only when policies are recommended but limited scientific evidence of effectiveness is available.

* The American Heritage Dictionary defines credible as 'capable of being believed; plausible.' and 'worthy of confidence; reliable.' To be considered an 'expert recommendation,' policies and programs must be recommended by one or more organizations that are recognized for their impartial expertise in the area of interest and have limited evidence available.

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Impact on Health Disparities

Likely impact of a given policy or program on racial/ethnic, socioeconomic, geographic or other disparities in Wisconsin based on its characteristics (e.g., target audience, mode of delivery, etc.) and best available evidence related to disparities.

  • Likely to decrease disparities
  • No impact on disparities likely
  • Likely to increase disparities