Online Program

What makes patient navigation most effective: Defining most useful tasks and activities

Wednesday, November 6, 2013 : 11:30 a.m. - 11:45 a.m.

Karen M. Freund, MD, MPH, Associate Director for Research Collaboration, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
Arpita Aggarwal, MD, Msc, Department of Internal Medicine, Virginia Commonwealth Univeristy, Richmond, VA
Tracy A. Battaglia, MD, MPH, Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA
Jack Clark, PhD, Health Policy and Management, Boston University School of Public Health, Boston, MA
Victoria Parker, DBA, Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
Introduction: To explore the association between patient navigators' activities and time to diagnostic resolution for abnormal cancer screening tests.

Method: We observed 34 patient navigators in 2-7 hour sessions as they worked in 9 sites of the national Patient Navigation Research Program (PNRP). We used a previously developed observational tool to record the frequency (per hour) of five tasks performed by trained navigators: A. Navigating with specific patients B. Facilitating for specific patients C. Maintaining system for all patients D. Documenting/Reviewing E. Other activities ( provide clinic back-up, do non-navigation tasks) Clinical data from patients enrolled in the navigated and control arm of the PNRP were used to assess outcomes; the proportion of subjects who completed diagnostic evaluation of a cancer screening abnormality within one year. We calculated the correlation (R2) between frequency of the task with the rate ratio of improved diagnostic resolution to assess which tasks had the greatest impact on the patient outcome.

Results: Sites with the highest rates of navigators directly navigating or facilitating with patients had the highest ratios of diagnostic resolution relative to controls (R2=0.40 and 0.28, respectively). Sites with navigators working with medical records documentation, with no direct patient contact, were associated with a longer time for diagnostic evaluation for abnormal cancer screening test.

Conclusion: Sites where navigators spend the most time directly working with patients, and have limited documentation time, appear to be most effective in facilitating timely cancer care.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Program planning

Learning Objectives:
Demonstrate the impact of navigation task on timely diagnostic evaluation for abnormal cancer screening test. Compare the effectiveness of navigation tasks and activities on timely diagnostic evaluation for abnormal cancer screening test.

Keyword(s): Cancer, Case Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator of the Boston Patient Navigation REserach Program, Chair of the Design and Analysis Committee of the national Patient Navigation Researach Program, and have been responsible for the design and analysis of the data presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.