Effectiveness of an EHR-Based Patient Navigation Program in Reducing Lag Time to Colorectal Cancer Screening Completion
Introduction
Colorectal cancer (CRC) is a significant public health concern, and early detection through timely colonoscopy completion plays a crucial role in reducing morbidity and mortality associated with this disease. Patient navigation programs have emerged as a promising intervention aimed at improving access to and adherence to CRC screening recommendations. These programs provide personalized support and guidance to patients throughout the CRC care continuum, addressing potential barriers and enhancing patient engagement. Findings from four years (2016-2019) of a CPRIT-funded project (PP160122) are presented here.
Methods
A retrospective study was conducted to investigate the impact of a patient navigation program on the lag time to CRC screening completion, in comparison to usual care. Age-eligible participants (aged 45-75) with a CRC screening order in the EHR (FIT or colonoscopy) were categorized into two study groups: patient navigation (intervention) and usual care. Relevant data, including age, sex, race/ethnicity, Boston Bowel Preparation Scale (BBPS) scores, presence of high-risk conditions (personal history of CRC, precancerous polyps, and inflammatory bowel disease), and the lag time to FIT and colonoscopy completion, were collected from the EHR-based patient navigation workbench. Multiple linear regression analysis was performed to explore the relationships between the intervention group and the lag time to colonoscopy or FIT completion while controlling for age, race/ethnicity, BBPS scores, and high-risk conditions.
Results
A total of 28,705 age-eligible individuals (mean age 58.5 ± 5.8 years) completed a FIT, and 18,915 (mean age 58.4 ± 11.6 years) completed a colonoscopy during the project period. The mean lag time to FIT completion was 26.8 days (SE: 0.34) for patients who received dedicated FIT patient navigation, compared to 44.4 days (SE: 0.67) for usual care. The mean lag time for colonoscopy completion for those who received dedicated colonoscopy patient navigation was 34.9 days (SE: 0.47), compared to 47.9 days (SE: 0.78) for usual care. In the multiple linear regression analysis adjusting for age, sex, race/ethnicity, presence of high-risk conditions, and BBPS scores, EHR-based CRC patient navigation was significantly associated with a decrease in lag time to FIT and lag time to colonoscopy completion (β: -0.18, p<0.001; β: -0.147, p<0.001, respectively).
Conclusion
After adjusting for demographic and clinical factors, the multiple linear regression analysis revealed that the EHR-based CRC patient navigation program was independently associated with reduced lag times for both FIT and colonoscopy completion. These findings indicate that the implementation of the EHR-based patient navigation program effectively expedited the screening process for CRC, potentially leading to earlier detection and improved patient outcomes. Further research and randomized controlled trials are warranted to validate these results and establish the intervention's effectiveness more definitively.