The Effect of a Patient Navigator Program on the Volume of Colonoscopy; Results from the First Year of Implementation: 467

Purpose: In 2008, New York Presbyterian Hospital - Columbia, with support from the Citywide Colon Cancer Control Coalition (C5) and the New York City Department of Health and Mental Hygiene, instituted a patient navigation and direct endoscopic referral system with the goals of increasing colorectal cancer screening rates among urban minorities. We aimed to quantify the effect of the navigation program on overall rates of colonoscopy in our institution, which caters to a socioeconomically diverse patient population. Methods: Patients referred by their primary care provider were contacted by a patient navigator (n=2), who reviewed the pre-colonoscopy instructions in detail. A patient navigator contacted each patient 48 hours prior to the colonoscopy to review the preparation instructions. We calculated the number of colonoscopies performed at our institution during the first 11 months of the patient navigation program to the 11 month period immediately preceding the onset of this program. We conducted a stratified analysis according to Medicaid status so as to assess the secular trend of screening rates. Results: We identified 619 patients who underwent colonoscopy through the patient navigation program. The mean (±SD) age was 60.2 (±8.2) years. Patients undergoing colonoscopy for average-risk screening accounted for 79% of the cohort, and patients with a history of adenomas or a family history of colorectal neoplasia comprised 7% and 4% of the cohort respectively. The remaining patients underwent colonoscopy for diagnostic purposes other than screening. Male patients comprised 41% of the cohort. A fellow participated in 28% of the examinations. Comparing the first 11 months of the navigator program to the 11 month period preceding its onset, the total number of colonoscopies increased by 12% (4,642 to 5,190). Among outpatients with Medicaid, colonoscopy volume increased by 58% (876 to 1,381). In contrast, among outpatients with insurance other than Medicaid, there was a 1% increase in the volume of colonoscopy comparing the two time periods (3,401 to 3,444), and among inpatients, there was no change (365 to 365). Conclusion: We observed an increase in the volume of colonoscopy in our institution coinciding with the onset of the C5-supported patient navigation program. Stratified analysis demonstrates that this overall increase in volume is largely attributed to a rise in colonoscopies among Medicaid outpatients, the principal focus of the navigator program. Rather than offering another route for patients who were destined to undergo screening colonoscopy, patient navigation appears to increase screening rates in the targeted population at our institution.