Assessing the successes and challenges of recruiting insured women for patient navigation services in the Maryland Breast and Cervical Cancer Program

Transcription

1 Assessing the successes and challenges of recruiting insured women for patient navigation services in the Maryland Breast and Cervical Cancer Program Elizabeth A Salerno, PhD, MPH Candidate Preceptors: Erin Penniston, MSW Ken Lin Tai, MD, MPH Rebecca McCoy, MPH Johns Hopkins Bloomberg School of Public Health

2 Patient Navigation (PN) o Originated in 1990 Freeman Introduction Harold o Designed to navigate individuals through cancer care Nationwide, PN programs have improved: o Screening rates o Adherence to diagnostic services o Diagnostic resolution Wells et al., 2008; Paskett, Harrop & Wells, 2011; Freeman & Rodriguez, 2011; Robinson-White, Conroy, Slavish & Rosenzweig, 2010;

3 Introduction Maryland Breast & Cervical Cancer Program (BCCP) o Center for Cancer Prevention & Control o Screening, diagnosis, patient navigation for over 25 years Implementation of Affordable Care Act (ACA) o 43,000 MD women provided with insurance 1 o Obstacles to utilization 22 local BCCPs across MD o One size fits all? 1 Calculated using the difference between SAHIE 2014 estimates and Census American Fact Finder 2014 estimates of Maryland women meeting PN eligibility criteria.

4 Aims & Objectives 1. Qualitatively assess the current status of local BCCPs recruitment approaches 2. Leverage evaluations to identify best practices, develop training materials Increase number of eligible MD women enrolled in patient navigation

5 Methods Phase 1 Key Informant Interviews Coordinators at local BCCPs selected by past performance, location Key Questions: Informant o Previous literature Interviews o Past experience o Semi-structured Recorded, transcribed, examined Phase 2 Statewide Survey Ascertain strengths, weaknesses, differences Developed by all staff 21 questions Delivered electronically via Statewide SurveyMonkey Survey

6 Findings Phase 1 Key Informant Interviews 8 interviews Themes: o minutes Strengths to recruitment: o Partnership with Federally Qualified Health Center (FQHC) o Establishing trust with clients Challenges to recruitment: o No discernible barriers thus women are ineligible o Disinterest among women reached Wide variation depending on location of local BCCP

7 Findings Phase 2 Survey 23 total responses Themes: Commonly used strategies are not working o Health fairs, churches/salons, newspaper/radio ads o Failing to target desired population Mixed partnerships with FQHCs o Strong or weak relationship dictates recruitment Need improved communication among BCCPs o Satisfaction with other programs was split o Successful programs don t feel the need to share

8 Recommendations 1. Specific Recruitment Strategies Local: Reconsider health fairs, newspaper and radio ads, churches/salons as primary recruitment efforts State: Provide guidance for partnerships and activities (Learn of Program codes, etc.) 2. Targeting FQHCs & Doctors Offices State: target these centers, research other efforts (other states or nationwide) to bridge the gap o Ideally from an entity other than the local BCCP

9 Recommendations 3. County-to-County Communications State: create a forum through which local BCCPs can share their success and challenges o o Important to incentivize Geography- or population-specific for effective implementation

10 Limitations & Challenges Finding an affordable transcription service for key informant interviews Maintaining focus on recruitment Survey response rate

11 Lessons Learned Moving my cancer experience across the cancer continuum Prevention Treatment Survivorship Inner workings of governmental agencies o Understanding is essential for disseminating research findings o Experience I will carry forward to NCI Qualitative data Collaborative nature of Maryland Department of Health

12 Policy & Practice Implications Applicable to overall program and not just recruitment o Timely in revitalizing partnerships Recommendations to improve recruiting strategies Significantly impact lives of MD residents o More women enrolled in PN o Reduced cancer burden o Lives saved

13 Acknowledgements Erin Penniston, MSW Ken Lin Tai, MD, MPH Rebecca McCoy, MPH Sara Seitz, MPH BCCP Team at MDH Beth Resnick, DrPH, MPH Paulani Mui, MPH Audrey Garman

14 References Freeman, H. P., & Rodriguez, R. L. (2011). History and principles of patient navigation. Cancer, 117(S15), Wells, K. J., Battaglia, T. A., Dudley, D. J., Garcia, R., Greene, A., Calhoun, E.,... & Raich, P. C. (2008). Patient navigation: state of the art or is it science?. Cancer, 113(8), Paskett, E. D., Harrop, J., & Wells, K. J. (2011). Patient navigation: an update on the state of the science. CA: a cancer journal for clinicians, 61(4), Robinson-White, S., Conroy, B., Slavish, K. H., & Rosenzweig, M. (2010). Patient navigation in breast cancer: a systematic review. Cancer nursing, 33(2), Freund, K. M., Battaglia, T. A., Calhoun, E., Darnell, J. S., Dudley, D. J., Fiscella, K.,... & Murray, D. M. (2014). Impact of patient navigation on timely cancer care: the Patient Navigation Research Program. Journal of the National Cancer Institute, 106(6), dju115. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), Couper, M. P., Traugott, M. W., & Lamias, M. J. (2001). Web survey design and administration. Public opinion quarterly, 65(2),