The purpose of this application is to develop a patient navigation intervention for lower income patients in Chicago, Illinois, who need follow-up care for positive cancer screening tests of the prostate, colorectum, breast and cervix. We plan to create a patient navigator program, which interfaces with individuals, who although poor, have guaranteed financial access to follow-up care after a positive screening test is reported. Veterans will receive follow-up care through the Jesse Brown Chicago VA and affiliated Lakeside Community Based Outpatient Clinic (VA) health system (for prostate and colorectal cancer) and patients who receive care at Access Community Health Network (ACCESS) will receive follow-up care through the Medicaid insurance program (for breast and cervical cancer, as part of the Illinois Breast and Cervical Cancer Treatment Act). The proposed patient navigator will be closely integrated with the Veterans'Health Administration (Lakeside and Westside locations) and ACCESS, a Public Health Service-designated 330 Federally Qualified Health Center organization. This program is built, in part, upon a pre-existing navigator program (from the American Cancer Society / Centers for Disease Control funded Racial and Ethnic Approaches to Community Health (REACH) 2010 project). In 2003, 150 Veterans were diagnosed with prostate cancer and 120 diagnosed with colorectal cancer each year at the Jesse Brown VA medical center, while 152 women with breast cancer and 259 women with cervical cancer were identified at ACCESS. Through this program it is estimated that 9400 persons with abnormal screening tests for prostate, colorectal, cervical and breast will be navigated.
The specific aims of this application are to: 1) increase the proportion of patients with diagnostic evaluations amongst the navigator interventions sites as compared to both previous performance and the usual care control sites;2) for patients who do get follow-up diagnostic evaluations to improve mean time to a diagnostic resolution between abnormal screening and definitive follow-up for the intervention sites as compared to both previous performance and to the usual care control sites
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