Acknowledgments Rebecca Glover-Kudon, PhD, MSPH Amy DeGroff, PhD, - PDF document

9/10/2012 National Breast and Cervical Cancer Early Detection Program’s Patient Care Coordination Demonstration Project Kristine Gabuten Allen, MPH, CHES Evaluation Team Program Services Branch GASCO Annual Meeting September 8, 2012 National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control Acknowledgments  Rebecca Glover-Kudon, PhD, MSPH  Amy DeGroff, PhD, MPH  Elizabeth Rohan, PhD, MSW  Kate Roland, MPH  Quanza Brooks-Griffin, MPA 1

9/10/2012 Disclaimer The findings and conclusions in this presentation are those of the presenters and do not necessarily represent the views of the Centers for Disease Control and Prevention. Objectives By the end of the presentation, participants will be able to describe:  the CDC care coordination demonstration project  patient navigation measures  common patient barriers addressed through patient navigation  components of the implementation evaluation 2

9/10/2012 Presentation Outline  Program background and context  Overview of the funded programs  Logic model  Program models and activities  Measures and evaluation  Lessons learned BACKGROUND AND CONTEXT 3

9/10/2012 National Breast and Cervical Cancer Early Detection Program (NBCCEDP)  Created by Breast & Cervical Cancer Mortality Prevention Act of 1990  Established to provide access to screening and diagnostic services for underserved women National Breast and Cervical Cancer Early Detection Program (NBCCEDP)  Since 1991: 6 7 Screening Delivery System s  >4.2 million women screened W A  53% are of minority ME MT ND MN OR VT race or ethnic NH I D W I NY MA SD MI CT W Y background RI I A PA NE DC NJ NV I L I N OH UT  >10.4 million breast DE CA CO W V VA MD KS MO KY and/or cervical cancer NC AK TN screening examinations AZ NM OK AR SC MS AL GA completed HI HI LA TX AMERI CAN SAMOA  54,276 breast cancers NORTHERN MARI ANA I SLANDS FL GUAM PUERTO RI CO detected REPUBLI C of PALAU  3,113 invasive cervical Am erican I ndian I nitiative: Native American Rehabilitation Assn of the Northwest, Inc Arctic Slope Native Assn, Ltd – North Slope Borough, Barrow, AK Navajo Nation – Window Rock, AZ Cherokee Nation – Tahlequah, OK cancers detected Cheyenne River Sioux Tribe – Eagle Butte, SD South Puget Intertribal Planning Agency – Shelton, WA Hopi Tribe – Kykotsmovi, AZ Southcentral Foundation – Anchorage, AK Kaw Nation – Kaw City, OK Southeast Alaska Regional Health Consortium – Sitka, AK Yukon-Kuskokwim Health Corp – Bethel, AK Source: April 2012 MDE submission 4

9/10/2012 More than just screening and diagnosis  Program management  Data management  Quality assurance / quality improvement  Professional development  Public education/ Targeted outreach  Patient navigation / Case management Additional Context  Patient Protection and Affordable Care Act of 2010  Full implementation in 2014  Extends healthcare coverage to previously uninsured persons  Ensures greater access to preventive care, including cancer screening  Presents opportunity for public health to partner with larger personal health systems 5

9/10/2012 National Prevention Strategy  Maintain a skilled, cross- trained, and diverse prevention workforce, including Patient Navigators (PNs) and Community Health Workers (CHWs) CDC Efforts Around CHW/PN Workforce Development  CDC CHW Policy Brief  ASTHO Brief  50 of 69 state cancer control plans include references to:  CHWs, patient navigators, outreach workers, community health representatives, promotores, community health advisors, lay health educators, lay health advisors, or peer educators. 6

9/10/2012 What Defines Patient Navigation? “Individualized assistance offered to patients, families, and caregivers to help overcome healthcare system barriers, and facilitate timely access to quality health and psychosocial care from pre-diagnosis through all phases of the cancer experience.” - Association of Oncology Social Workers, • Nurse Navigators Oncology Nursing Society, and C-Change • Social Work Navigators • Lay Navigators • May be Community Health Workers (CHWs) • Often supervised by social worker or nurse http://www.aosw.org/ ; http://www.ons.org/ ; http://c-changetogether.org/ CARE COORDINATION OVERVIEW 7

9/10/2012 Project Overview  Purpose – Demonstrate expanded roles for state health departments in the early detection of breast and cervical cancer through targeted outreach, patient navigation, and case management  Objectives  Create and implement changes in operational systems, policies, and/or practices to improve coordination of cancer prevention and early detection activities  Extend existing patient navigation and case management activities into larger health settings to provide these essential services to additional program-eligible women, not currently covered by NBCCEDP-funded services Care Coordination Program Grantees WA ME MT ND MN OR VT NH ID WI NY MA SD MI CT WY RI IA PA NE NJ DC NV OH IL IN UT DE CA CO WV MD KS VA MO KY NC AK TN AZ NM OK AR SC MS AL GA HI HI LA TX FL Care Coordination Grantees NewJersey Alabama NewYork Colorado SouthDakota Connecticut Texas Louisiana Virginia Maryland Wisconsin 8

9/10/2012 LOGIC MODEL NBCCEDP Care Coordination Logic Model IF we conduct these activities THEN we expect these outcomes Long-term Intermediate Immediate Short-Term Inputs Activities Outcomes Outcomes Outputs Outcomes Infrastructure/System Infrastructure/System Infrastructure/System • Expanded and integrated PN • # / type of expanded health • Sustainable PN Infrastructure/System care settings programs in community programs in community • Work with new health care • # / type systems/policy CDC Funds and providers change Technical Support Patient Navigators • Support systems & policy • Competent & culturally change within health care Patient Navigators Patient Navigators sensitive PNs delivery system • Increased knowledge of • Qualified PN Staff retained • # / type PNs employed • PN supervision provided community & health care system • Program able to recruit and supervise qualified PNs • # trained / # training • Increased knowledge of breast Patient Navigators • satisfaction with training and cervical cancer • PN recruitment and Reduced &/or • Increased skills for delivering employment eliminated NBCCEDP Care navigation activities Navigated Patients health • PN training design and Coordination • #/type of outreach activities delivery disparities Supplemental • # recruited for navigation • Increased access and Resources adherence to breast and Improved Navigated Patients Patient •Grantee institution • Patient demographics cervical cancer screening, disease-specific Navigation • Increased access to health infrastructure (e.g., • # patients assessed diagnostic services, and outcomes care coverage resources, staff, • # navigated for screening cancer care for patients expertise) • Increased access to screening Patient outreach and • # navigated for diagnosis experiencing health Decreased and diagnostic services recruitment • #/type of barriers identified disparities •Grantee Partners morbidity & •Reduced barriers to care mortality due to • Improved coordination of • # / type (individual, group) breast and •Increased adherence to Patient assessment and barrier care among & between of education delivered cervical disease screening/diagnostic/treatment identification (geographic, public health, medical, recommendations language, cost, education, social service, & community • Reduced no-show rate for cultural, anxiety, fatalism) personnel/providers appointments • # / type of PN activities • Improved timeliness for •Improved adherence to delivered to reduce barriers diagnostic resolution and screening guidelines • Time spent to navigate treatment initiation Patient education •Improved screening • Reduced lost-to-follow-up • # / type of reminders prevalence in communities • Improved patient and provider provided; # patients tracked Resolution of patient barriers satisfaction • Increased screening prevalence • Data collected and reported Patient tracking and follow-up within health care setting (e.g., # assessment forms completed, # PN log forms • Increased cost efficiencies completed) Data collection and reporting Contextual & External Factors Broader NBCCEDP program, grantee institutional setting; partner organizations; service delivery context; unexpected positive and negative events during project (e.g., changes in Medicare/Medicaid funding; other navigation programs) 9

9/10/2012 CHARACTERISTICS OF PROGRAM MODELS Priority Populations  Specific populations identified  Race/ethnicity  Rural populations  Example  Women in rural areas  American Indian populations 10

9/10/2012 Geographic Reach Type Grantee City MD County AL, MD, NJ Region LA, NY, TX, VA, WI State CT, CO Reservation SD Program Setting  Federally Qualified Health Centers  County Health Departments  Community Clinics  Hospitals  University Health Systems  Urban Indian Health Clinics 11