Denver Health Patient Navigator Research Program

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Denver Health Patient Navigator Research Program
Peter Raich, M.D. Principal Investigator Elizabeth
Whitley, Ph.D., R.N. Co-Principal Investigator
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911 Medical Response
Denver Health Medical Center
Rocky Mountain Poison and Drug Center
Correctional Care
Denver Public Health
Family Health Centers
Denver CARES
Denver Health Foundation
Denver Health Medical Plan
Rocky Mountain Regional Trauma Center
Rocky Mountain Center for Medical Response to
Terrorism
School-based Health Centers
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Patient Population

• gt144,000 individual patients
• 52 Latino
• 14 African American
• 27 White
• 1 Native American
• lt 1 Asian
• 5 unknown race/ethnicity

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Patient population

• gt 40 are uninsured
• DH provided over 275,000,000 of uncompensated
  care in 2006

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Navigating the Healthcare System
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Denver Health Improving Patient Outcomes through
System Navigation

• Collaboration between Denver Health, University
  of Colorado at Denver and Health Sciences Center
  Comprehensive Cancer Center, Preventive Medicine
  Biometrics and Colorado Health Outcomes Center

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Proposed Outcomes Aims 1-2 (breast, colorectal
and prostate)

• Aim 1 To reduce the time between abnormal
  screening test to a positive/negative confirmed
  diagnosis
• Aim 2 Reduce the time from a positive diagnosis
  to the start of therapy

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Proposed Outcomes Aims 3, 4 5

• Aim 3 To increase the proportion of patients
  adhering to recommendations for care, including
  completion of additional diagnostic tests,
  consultation appointments and treatment
• Aim 4 To improve patient reported medical
  self-efficacy, satisfaction with care, reduced
  barriers to care, and distress across the entire
  cancer care experience
• Aim 5 To examine the cost-effectiveness of
  patient navigation

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Denver Health Improving Patient Outcomes through
System Navigation

• 4.5 FTE PNs work with Breast, Prostate and
  Colorectal diagnostic screening and cancer
  patients
• Program includes 2 outcalls from UCDHSC Cancer
  Information and Counseling Line (CICL)
• Post intervention surveys by UCDHSC Computer
  Assisted Telephone Interview (CATI) unit

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Definition of Patient Navigation

• Patient Navigators are trained, culturally
  effective healthcare workers who assist patients
  to overcome barriers to care, negotiate
  healthcare systems and access quality care.

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What Do Patient Navigators Do?

• Patient Navigators identify barriers and
  implement strategies to eliminate or reduce the
  barriers

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Examples of Barriers

• Transportation
• Housing
• Language
• Literacy
• Un or under Insured
• Financial

• Communication with providers
• Fear
• Work schedule conflicts
• Co-morbidities
• Patient Disabilities
• System scheduling issues

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Study Population

• Expected Patient Accrual between 2006-10
• 1550 screening patients
• 250 cancer patients
• 1800 total

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Status Update

• Enrollment began 10/1/2006
• Accrual (1/31/08)
• 252 screening patients
• 40 cancer patients
• 292 total

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Emerging Issues

• Compare efficacy and cost effectiveness of lay
  and professional Patient Navigators
• Training, certification and credentialing
• Differentiation between Patient Navigators,
  Community Outreach Workers and Case Managers

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Challenges

• Identification of potentially eligible
  participants
• Evolving standards of Care, i.e., Colonoscopy
• Proliferation of Patient Navigator Programs

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Denver Health Patient Navigator Research Program
Contact information Peter Raich,
peter.raich_at_dhha.org Elizabeth Whitley,
lwhitley_at_dhha.org Patricia Valverde,
patricia.valverde_at_uchsc.edu