Clinical case management and navigation for colonoscopy screening in an academic medical center

Authors

  • Mary F. Cavanagh MD, MPH,

    Corresponding author
    1. Health Promotion Disease Prevention Program Physician Manager, Northport Veterans Affairs Medical Center, Northport, New York
    • Corresponding author: Mary F. Cavanagh, MD, MPH, Primary Care, Northport VA Medical Center, 79 Middleville Road, Northport, NY 11768; Fax: 631-486-6134; Mary.Cavanagh2@va.gov

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  • Dorothy S. Lane MD, MPH,

    1. Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
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  • Catherine R. Messina PhD,

    1. Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
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  • Joseph C. Anderson MD

    1. Department of Medicine, White River Junction VA Medical Center, White River Junction, Vermont
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  • The articles in this supplement were commissioned based on participation in evaluating the Centers for Disease Control and Prevention-funded Colorectal Cancer Screening Demonstration Program.

  • The opinions or views expressed in this supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the journal editors, the American Cancer Society, John Wiley & Sons, Inc., or the Centers for Disease Control and Prevention.

  • At the time of this project, Dr. Cavanagh was at the Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, and Dr. Anderson, was at the Department of Gastroenterology and Hepatology, Stony Brook University Medical Center, Stony Brook, NY.

  • We thank all of the collaborators of the Stony Brook University Medical Center SCOPE Project, who are listed elsewhere in this supplement.

Abstract

BACKGROUND

One of 5 nationally funded Centers for Disease Control and Prevention Colorectal Cancer (CRC) Screening Demonstration Programs, Project SCOPE, was conducted at an academic medical center and provided colonoscopy screening at no cost to underserved minority patients from local community health centers.

METHODS

Established barriers to CRC screening (eg, financial, language, transportation) among the target population were addressed through clinical coordination of care by key project staff. The use of a clinician with a patient navigator allowed for the performance of precolonoscopy “telephone visits” instead of office visits to the gastroenterologist in virtually all patients. The clinician elicited information relevant to making screening decisions (eg, past medical and surgical history, focused review of systems, medication/supplement use, CRC screening history). The patient navigator reduced barriers, including, but not limited to, scheduling, transportation, and physical navigation of the medical center on the day of colonoscopy.

RESULTS

Preprogram preparation was vital in laying groundwork for the project, yet enhancements to the program were ongoing throughout the screening period. Detailed referral forms from primary care physicians, coupled with information obtained during telephone interviews, facilitated high colonoscopy completion rates and excellent patient satisfaction. Similarly valuable was the employment of a bilingual patient navigator, who provided practical and emotional patient support.

CONCLUSIONS

Academic medical centers can be efficient models for providing CRC screening to disadvantaged populations. Coordination of care by a preventive medicine department, directing the recruitment, scheduling, prescreening education, and the evaluation and preparation of target populations had an overall positive effect on CRC screening with colonoscopy among patients from a community health center. Cancer 2013;119(15 suppl):2894–904. © 2013 American Cancer Society.

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