Patient navigation is increasingly used to address patient barriers to care, such as insurance status, limited English proficiency, cultural isolation, low health literacy, low patient activation and medical distrust. After the success of our patient navigation work in DuPage County, IL, we have extended our patient navigation impact through several meaningful projects.
Chinese women in Chicago have unacceptably low breast and cervical cancer screening rates. Using a community-based participatory research approach and leveraging well-established partnerships among the Chinese American Service League, Mercy Hospital and Medical Center, Rush University Institute for Healthy Aging, and Northwestern University, this study expands and evaluates a well-tested patient navigator (PN) model to promote breast and cervical cancer screening and follow-up among Chinese women in Chicago’s Chinatown. Results provide insight into what determines the effectiveness of PNs as health educators, how to encourage breast and cervical cancer screening, and how PNs can become trusted and respected community health workers and advocates that provide essential links between the community and the health care system. Findings from this study will also help develop effective and culturally tailored community-based health programs to eliminate health disparities for Chinese American women. As part of our community-engaged strategy, we conduct ongoing outreach in Chinatown community settings to provide information on topics such as breast and cervical cancer screening, insurance status, access to care, and cultural factors related to screening. (NIH NCI R01CA163830).
Accomplishments to date:
- Between July 2013 - July 2017, we provided navigation services to 750 women.
- Focus groups among a convenience sample of Chicago Chinatown women explored their experiences with the U.S. health care system and identified cultural and contextual barriers and facilitators to inform intervention adaptation.
- Results from our hybrid type 1 implementation research study forthcoming.
To ensure that women in all communities throughout the state of Illinois have access to high quality mammograms and breast cancer treatment, the Illinois Department of Healthcare and Family Services (HFS) and the Department of Public Health launched the Breast Cancer Quality Screening and Treatment Initiative. This initiative created patient navigator pilot projects at two hospitals and two Comprehensive Care Plans that serve Medicaid patients across Chicago, its suburbs/collar counties, and in downstate Illinois. This study utilizes HFS data to analyze the screening mammography rates and change in time to diagnostic mammography follow-up of an abnormal screening mammogram for the population of female age 40-65 Medicaid enrollees living in the pilot projects’ catchment areas, and the projects’ different approaches and identified best practices in navigating Medicaid enrollees through the complexities of breast cancer treatment. Findings from our evaluation of the pilot navigation studies will help guide future discussions with HFS to identify strategies for scaling navigation as well as the design of policies to address the growing need for navigators in health care delivery systems. This evaluation study further demonstrates Northwestern’s commitment to continuing its partnership with HFS to thoughtfully scale navigation programs in a climate of increasing fiscal constraints. (Illinois Department of Health and Family Services)
Accomplishments to date:
- HFS data analysis of the Hospital Pilot Navigation Program was designed to assess changes in mammography screening rates and reduction of follow-up time after an abnormal screening mammography result. The evaluation found that the patient navigation pilot was associated with an increased number of screens performed at Mercy Hospital and reduced abnormal screening follow-up time.
- Analyses of our qualitative data suggest that navigators provided support to patients using a variety of strategies, including addressing patient concerns; providing language support; building trust; emphasizing health education; engaging patients outside the hospital in community settings; connecting patients to social services such as affordable housing and transportation; coordinating inter-agency communication; and ensuring patient care logistics.
- We have been able to assess breast and cervical cancer screening rates for community areas in 18 unique zip codes in and around the Chicagoland area, allowing us to focus future intervention efforts on those areas where screening rates are low.
The efforts of this project is focused on improving Chicago’s breast cancer mortality disparities- which are among the worst in the U.S. Together with Mount Sinai Urban Institute’s (SUHI) Helping Her Live Program to improve mammography screening, we aim to build a robust community navigation model in Chicago Lawn, a low income community that is approximately half Latino and half African American. Specifically, we aimed to address three keys to breast health: routine mammography, timely resolution of abnormal mammograms, and timely treatment for women with cancer. In order to accomplish these goals, a variety of outreach methods were developed by SUHI for the project’s original west side target area, including conducting workshops, attending events like community forums and health fairs, doing table set-ups and one-on-one canvassing at local churches, schools, food pantries, etc. Community Health Educators (CHEs) living in the communities are recruited to act as navigators, helping women overcome any barriers to care. (Lynn Sage Cancer Research Foundation)
Accomplishments to date:
- Since the partnership between SUHI and Dr. Simon’s research lab in 2013, almost 900 women have signed up for mammogram navigation services and over 500 have successfully completed mammography screening.