Patient navigation for breast and colorectal cancer in 3 community hospital settings: An economic evaluation

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. .
Cancer (Impact Factor: 4.89). 10/2012; 118(19):4851-9. DOI: 10.1002/cncr.27487
Source: PubMed


The Ralph Lauren Cancer Center implemented patient navigation programs in sites across the United States building on the model pioneered by Harold P. Freeman, MD. Patient navigation targets medically underserved with the objective of reducing the time interval between an abnormal cancer finding, diagnostic resolution, and treatment initiation. In this study, the authors assessed the incremental cost effectiveness of adding patient navigation to standard cancer care in 3 community hospitals in the United States.
A decision-analytic model was used to assess the cost effectiveness of a colorectal and breast cancer patient navigation program over the period of 1 year compared with standard care. Data sources included published estimates in the literature and primary costs, aggregate patient demographics, and outcome data from 3 patient navigation programs.
After 1 year, compared with standard care alone, it was estimated that offering patient navigation with standard care would allow an additional 78 of 959 individuals with an abnormal breast cancer screening and an additional 21 of 411 individuals with abnormal colonoscopies to reach timely diagnostic resolution. Without including medical treatment costs saved, the cost-effectiveness ratio ranged from $511 to $2080 per breast cancer diagnostic resolution achieved and from $1192 to $9708 per colorectal cancer diagnostic resolution achieved.
The current results indicated that implementing breast or colorectal cancer patient navigation in community hospital settings in which low-income populations are served may be a cost-effective addition to standard cancer care in the United States. Cancer 2012. © 2012 American Cancer Society.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To address the value of patient navigation (PN) to a community cancer center and suggest ways to measure PN outcomes to justify it as a critical component of cancer care. Literature review and unpublished data from the DC Citywide Patient Navigation Network. Economic challenges in health care necessitate justification and appropriate utilization of all specialties and roles in cancer care. Demonstrating the value of PN programs is critical for sustaining these programs in community cancer centers. Having a clear business plan helps to define appropriate return-on-investment measures and an evaluation plan is important to assess program impact. Nurses play a key role in working with administrators to define value metrics, track these measures, and report the results. Nurses should also seek out training and resources to enhance knowledge and skills for navigating patients.
    Full-text · Article · May 2013 · Seminars in Oncology Nursing
  • [Show abstract] [Hide abstract]
    ABSTRACT: Access to rheumatology care can expedite diagnosis and treatment of rheumatic diseases and reduce disparities. We surveyed community health center (CHC) medical directors to evaluate rheumatology care in underserved areas and potential strategies for improvement. We identified 77 Massachusetts CHCs that provide adult medical services and sent a 40-item survey to their physician medical directors. Survey questions assessed the centers' prevalence of rheumatic diseases, prescribing practices of immunosuppressive medications, and possible interventions to improve care. We compared CHC characteristics and rheumatology-specific items and then stratified our data by the response to whether improved access to rheumatology care was needed. Qualitative data were analyzed thematically. Thirty-six CHC physician medical directors returned surveys (47% response rate). Fifty-five percent indicated a need for better access to rheumatology care. Eighty-six percent of CHC physicians would not start a patient with rheumatoid arthritis on a disease-modifying antirheumatic drug; 94% would not start a patient with systemic lupus erythematosus on an immunosuppressant. When we compared CHCs that reported needing better access to rheumatology care to those that did not, the former described a significantly greater percentage of patients with private insurance or Medicaid who required outside rheumatology referrals (P < 0.05). Language differences and insurance status were highlighted as barriers to obtaining rheumatology care. Sixteen directors (57%) ranked the patient navigator-a layperson to assist with care coordination-as their first-choice intervention. Community health center medical directors expressed a need for better access to rheumatology services. A patient navigator for rheumatic diseases was proposed to help improve care and reduce health disparities.
    No preview · Article · Sep 2013 · Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases

  • No preview · Article · Dec 2013 · Breast Diseases A Year Book Quarterly
Show more