Abstract B64: Impact of neighborhood effects on a multi-approach Colorectal Cancer screening navigation program in an urban federally qualified health center
Authors: Miguel Yazmin San , Molina Yamile , Miguel L. San , Grumeretz Scott , Matthews K. , Winn Robert , Watson Karriem 
Published: March 2017

Purpose.

Mortality and morbidity disparities exist in Colorectal Cancer (CRC). CRC screening rates differs among race/ethnicity, which contribute to these existing disparities. In response, multiple interventions have been developed and assed to address these gaps. Little is known about how efficacy varies across patient populations. In response, multiple interventions have been developed and assessed, including patient navigation. Little is known about how efficacy varies across socioenvironmental contexts.

Objective.

The study sought to examine the interactive effects of patient navigation and provider navigation with contextual factors (facility and residential neighborhood characteristics) on CRC screening uptake among a Chicago-based sample population.

Methods.

Two evidence-based CRC screening interventions were implemented at University of Illinois Mile Square Health Center (MSHC) clinics. The study eligible population was those: 1) Ages 50-75; 2) Had an appointment in 2014 or 2015; and 3) Not up-to-date on CRC screening. The controls were matched by clinic, race/ethnicity, and sex. An individual-level database for the retrospective evaluation of comparative effectiveness of patient navigation-based versus provider-based navigation was created. This database included all patients ages 50-75 who completed at least one patient visit in MSHC in 2015. The database includes patients navigated by the patient navigator, and patients navigated by the provider. The following information was collected from electronic medical record (EMR) data: 1) age; 2) race/ethnicity; 3) insurance status; 4) date mailed birthday reminder was sent; 5) type of one-on-one navigation (CHW, provider, or both); 6) date navigation was administered; 7) patient full address, including zip code; 8) date FOBt given to patient during 2015; 9) date FOBt returned; 10) date colonoscopy scheduled; 11) date colonoscopy completed;12) FOBt result; 13) Screening colonoscopy result; 14) Diagnostic colonoscopy date; 15) Diagnostic colonoscopy date; 16) Cancer Diagnosis date; 17) provider name; and 18) clinic site. The neighborhood characteristics of interest were median household income, poverty, percent black, percent white, and percent of Latino residents based on American Community Survey 2007-2011 data.

Results.

A preliminary analysis was conducted on the database, n= 340. There were significant differences in clinic using Chi-Square statistic (X= 10.7, p = .005). When looking at individual clinics, for the Englewood and Main clinic, patients responded better to provider navigation (20% and 21%) compared to patient navigation (8% and 15%), respectively. Whereas, the Back of the Yards clinic had patients respond better to provider navigation versus patient navigation, 56% versus 14%. Adjusted for clinic, gender, and race/ethnicity, patient navigation was most strongly associated with CRC completion (OR = 5.5, 95% CI:3.1-9.8, p = &lt;.0001). Provider navigation was associated with CRC completion (OR = 1.81, p = .04).

The next steps in the study analysis will be to complete the data abstraction with matched-controls and conduct multivariable spatial logistic and Cox regression models to compare the different types of navigation on a) date patient received FOBt and b) days to FOBt returned since date of navigation c) days to completed colonoscopy since date of navigation. Second, multiple effect modification analyses will be conducted to examine interactive effects by 1) race/ethnicity; 2) clinic site; and 3) neighborhood factors (concentrated disadvantage and racial/ethnic composition).

Conclusions.

In this sample, patient navigation as an intervention was most strongly associated with CRC completion, relative to those who received the standard CRC screening recommendations (controls). CRC screening can lead to increases early detection and improved outcomes. Navigation programs that are tailored to address specific populations can increase uptake and compliance and have far reaching implications in FQHC populations who carry some of the largest burden of cancer morbidity and mortality.

Citation Format: Yazmin San Miguel, Yamile Molina, L. San Miguel, Scott Grumeretz, K. Matthews, Robert Winn, Karriem Watson. Impact of neighborhood effects on a multi-approach Colorectal Cancer screening navigation program in an urban federally qualified health center. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B64.