Exploring the Impact of Patient Navigation on Colorectal Cancer Screening Rates among Clinics in Washington State

Abstract

Introduction: The Centers for Disease Control and Prevention (CDC) created the Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer (CRC) screening uptake. The CRCCP partners with primary care clinics to increase the implementation of evidence-based interventions (EBIs) and supporting activities (SAs) such as patient navigation (PN) in clinics. This thesis assesses the impact of newly implementing PN compared to continuing or enhancing PN on the change in CRC screening rate.Methods: Data from clinics participating in Washington state’s CRCCP from July 2022 to June 2024 was used to determine clinic characteristics and change in screening rate from program year (PY) 3 to PY4. Clinics were stratified into two groups: those that had newly implemented PN vs those that had continued or enhanced PN. I calculated descriptive statistics for clinic characteristics such as clinic size and percentage of uninsured patients stratified for each PN groups. Then I calculated the mean, median, range, and interquartile range for the change in CRC screening rate for each group and used a Mann-Whitney u-test to determine whether the distribution of the change in CRC screening rate was significantly different between the two groups. Results: The PN new and PN continuing/enhancing groups differed greatly in clinic characteristics such as clinic size (72.73% large clinics vs. 20.00% large clinics, respectively) and percentage of uninsured patients (45.45% with ≤5% uninsured vs. 100.00% with ≤5% uninsured). The PN new in PY4 group had a much lower median change in CRC screening rate (-0.17%) compared to the PN continuing in PY4 group (14.30%). The difference in the distribution between these groups was statistically significant (p-value = 0.00795). Discussion: Clinics that continued to implement or enhanced PN for more than one year experienced higher changes in CRC screening rate compared to those clinics that newly implemented PN. Conclusion: PN is a promising intervention that can increase CRC screening rates over time. My analysis found that continuing or enhancing PN can lead to a greater increase in screening rates than newly implementing PN among CRCCP participating clinics in Washington state. Future research should focus on understanding how these clinics are enhancing PN and how possible confounders impact the relationship between PN and CRC screening rates.