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Patient Navigation Interventions
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As a part of the Women’s Health Unit’s vision to lead the nation in the delivery of equitable, comprehensive, coordinated and compassionate women’s healthcare, much of the unit’s research has focused on patient navigation. First implemented in 1990 by Dr. Harold P. Freeman in Harlem, New York, patient navigation aims to target and eliminate barriers across the continuum of cancer for vulnerable populations. Through funding from Avon, Dr. Battaglia utilized the principles of patient navigation as defined by Dr. Freeman to conduct a patient navigation intervention in Boston for women with abnormal mammogram results. Subsequently, the Women’s Health Unit was a part of a nine-site National Cancer Institute Patient Navigation Research Program to clearly define patient navigation and test the effectiveness of the intervention. Since this study, the Women’s Health Unit has conducted several studies surrounding patient navigation, including a Patient Navigation Task Analysis and Project SUPPORT. Our current navigation study, Translating Research Into Practice (TRIP) is being rolled out at six hospitals across the city of Boston.
Avon
Through funding from Avon, Dr. Battaglia utilized the principles of patient navigation as defined by Dr. Freeman to conduct a similar study in Boston with women for timely follow up after an abnormal mammogram. The study assigned the participants a full time patient navigator to support the patients using the care management model. Timely follow-up of the participants was assessed utilizing data from computer registries, medical records and patient interviews. The study found that the patient navigation intervention improved timeliness of follow-up care for the women.
Patient Navigation Research Program (PNRP)
In 2007, the Women’s Health Unit was a part of a nine-site National Cancer Institute Patient Navigation Research Program to clearly define patient navigation and test the effectiveness of the intervention. The Patient Navigation Research Program defined patient navigation, designed and implemented a generalized patient navigation program, and evaluated the process and outcomes of this program in diverse settings. The findings of the program provided data to draw evidence-based conclusions to determine best practice models and provided a model of how to refine and expand the patient navigation model for other communities and diseases.
Patient Navigation Task Analysis
Given that so many cancer programs are adopting patient navigation, the Women’s Health Unit undertook a study to assess which navigator activities improved care for patients. We observed navigators within the Patient Navigation Research Program, and found navigator tasks that provided direct patient services (navigating with patients, working with doctors on behalf of patients) improved care, while systems-focused activities (documenting in the medical record) did not. These findings can help programs establish navigator competencies to maximize the impact of patient navigation services on disparities in cancer outcomes.
Project SUPPORT
Project SUPPORT was a randomized controlled trial at the largest safety-net medical center in New England, Boston Medical Center, to evaluate the effectiveness of traditional navigation compared to navigation with legal support by the Boston Medical Legal Partnership.
We randomized 300 low-income and racially diverse newly diagnosed cancer patients. The control arm received traditional navigation: a lay health worker integrated into the healthcare team who provides 1:1 patient contact to identify and address traditional system barriers to care. The intervention arm received traditional navigation enhanced by legal support including: a) a full socio-legal needs assessment and care plan in consultation with MLP, and b) pro bono direct legal assistance for eligible acute legal needs. We are comparing each group on patient-reported and clinical outcomes.
Translating Research Into Practice (TRIP)
The TRIP Project aims to improve the delivery of quality breast cancer care among vulnerable patients across six Boston hospitals through a coordinated care delivery model that includes: 1) Patient Navigation, 2) a shared regional registry for tracking patients over time, and 3) a standardized screening and referral tool for identifying and addressing barriers to care. Using this 3-part community-engaged intervention, TRIP aims to address barriers to care and reduce delays in time to initiation of treatment for Black women in Boston, ultimately improving disparities in breast cancer outcomes.