Background: Cancer continues to present a major challenge in the Washington, DC, metro area. The District has high mortality, morbidity, and inequity in cancer. For primary care, 25% of residents in the District are seen by the Federally Qualified Health Center (FQHC) community. Yet, in 2015, only 34% of eligible patients seen at FQHCs were screened for colorectal cancer. To improve access to cancer screenings and treatment for colorectal and breast cancer, DC Primary Care Association (DCPCA) and member health centers developed a health center–based patient navigation program.
Objectives: The program aims to increase screening rates for breast and colorectal cancer by 10% within 2 years for health centers implementing a patient navigation model to serve 500 patient cases a year.
Methods: Beginning October 1, 2016, DCPCA in partnership with MedStar Georgetown University Hospital employed 2 full-time navigators, each of whom is based in a DCPCA-affiliated FQHC. Due to the success of the program, DC Health funded the addition of another navigator in March 2018. Once patients are identified as due for screening, the navigators work to ensure the patient is referred to the appropriate cancer screening, and, as needed, diagnosis and treatment. Through this collaborative DCPCA-health center approach, patient navigators have access to best practices training, peer sharing opportunities, and, of crucial importance, a direct avenue for communicating feedback on the most complex system-level barriers to those District stakeholders who can best effectuate change.
Results: Improved cancer screening rates for the overall clinic patient population. Three navigators provide a comprehensive array of navigation services to 2300 patient cases each year. On average, 61% of patients referred to the navigators received a screening. Each health center saw an absolute increase in breast and colorectal cancer screening rates for their patient population ranging from 16% to 39%.
Creation of new clinic screening workflows, using best practices from cancer-focused private facilities, national bodies, and other navigators in DC. Navigators established a daily previsit planning, screening, and follow-up workflow for the clinic and worked with care teams to improve referral coordination. Further, navigators worked collaboratively to develop an EHR-based system to monitor progress and impact. Through peer shadowing, navigators quickly share best practices and catalyze change.
Data from navigation services inform identification and resolution of system challenges in the DC system. DCPCA leads a Patient Navigators for Cancer Peer Group with over 50 navigators across the District to provide training, discuss best practices, and collaborate to address system challenges and improve coordination of care. As navigators provide support to a patient through the full journey of care, they have a unique perspective on the strengths and challenges of the District cancer screening and care system. Our model provides a vehicle to sharing common barriers and solutions to District and national cancer coalitions and uses these coalitions as a platform for advocating for system-level challenges.
Conclusion: Health center–based patient navigators produce significant increases in cancer screening rates, and, through leveraging the strategic partnership of a primary care association, become a catalyst for system- wide change.
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