Increasing colonoscopy screening in disparate populations: Results from an evaluation of patient navigation in the New Hampshire Colorectal Cancer Screening Program

Abstract

Background: To investigate uniformly successful results from a statewide program of patient navigation (PN) for colonoscopy, this comparison study evaluated the effectiveness of the PN intervention by comparing outcomes for navigated versus non-navigated patients in one of the community health clinics included in the statewide program. Outcomes measured included screening completion, adequacy of bowel preparation, missed appointments and cancellations, communication of test results, and consistency of follow-up recommendations with clinical guidelines.

Methods: The authors compared a subset of 131 patients who were navigated to a screening or surveillance colonoscopy with a similar subset of 75 non-navigated patients at one endoscopy clinic. The prevalence and prevalence odds ratios were computed to measure the association between PN and each study outcome measure.

Results: Patients in the PN intervention group were 11.2 times more likely to complete colonoscopy than control patients (96.2% vs 69.3%; P<.001), and were 5.9 times more likely to have adequate bowel preparation (P =.010). In addition, intervention patients had no missed appointments compared with 15.6% of control patients, and were 24.8 times more likely to not have a cancellation <24 hours before their appointment (P<.001). All navigated patients and their primary care providers received test results, and all follow-up recommendations were consistent with clinical guidelines compared with 82.4% of patients in the control group (P<.001).

Conclusions: PN appears to be effective for improving colonoscopy screening completion and quality in the disparate populations most in need of intervention. To the best of our knowledge, the results of the current study demonstrate some of the strongest evidence for the effectiveness of PN to date, and highlight its value for public health. Cancer 2017;123:3356-66. © 2017 American Cancer Society.

Keywords: colonoscopy; disparate populations; outcome assessment; patient adherence; patient navigation; public health.

Figure 1

(Top) Flowchart of colonoscopy completions in the intervention group by test encounter level. (Bottom) Flowchart of colonoscopy completions in the control group by test encounter level. Both panels illustrate the number of complete and incomplete colonoscopies at each test encounter level and the number of colonoscopies not performed due to missed appointments and cancellations during the study time period. “Incomplete” denotes that the colonoscopy was performed but not completed by the endoscopist. This could be due to inadequate bowel preparation, inability to reach the cecum (anatomical endpoint), incomplete polyp removal, or medical complications during the procedure. “Not performed” denotes that the colonoscopy never occurred due to either a missed appointment (“no show”) or cancellation by the patient.