Patient Navigation 2.0: Addressing the Challenge of Scaling Navigation through Checklist-based Implementation

通过华裔美国服务联盟之间建立起来的研究伙伴关系 (CASL)、Mercy医院和医疗中心(Mercy)和西北大学(NU)，我们的团队完成了一项试验 评估针对芝加哥定制的乳腺癌和宫颈癌一对一患者导航(PN)干预 唐人街。我们完成的试验和其他人已经证明了PN在改善 在服务不足的人群中提供癌症护理和解决健康的社会决定因素(SDoH)。 不幸的是，如果没有密集的资金投入，当前标准的一对一PN很难扩展和持续 资源，这限制了一对一的癌症PN为支离破碎的医疗系统提供临时的“创可贴”。 我们有机会应用我们团队从完成的PN试验中学到的经验教训，以创建 PN的范式转变导致癌症护理提供的系统改变，以满足服务不足的人的需求 人口。为此，我们提出了一种学习卫生系统PN2.0核对表实现策略 跨癌症扩展PN的实施，并建立可持续的基于团队的核对表，以支持 协调和整合社区肿瘤学和社区社会服务领域的SDoH相关工作 设置。在目标1中，我们将采用共同创造和迭代原型的设计思维框架来开发 PN 2.0检查清单，将一对一的PN转变为以以下内容为中心的学习型健康系统PN方法 一份基于团队的清单，利用PN证据基础和社区肿瘤学的积极参与 和社区社会服务利益相关者。在目标2中，通过混合类型2随机有效性- 实施语用试验，我们将比较PN 2.0检查表的有效性(非劣势) 相对于一对一PN解决SDoH障碍和增加患者对临床癌症预防的接受度 服务。从芝加哥唐人街招募的600名中国成年人将被随机分配到标准的一对一 癌症PN(对照组)或癌症PN 2.0检查表(干预)。主要结果是调整后的综合结果 SDOH障碍解决的比例和完成美国预防服务工作组建议的比例 通过图表回顾和患者收集的癌症相关筛查、行为咨询和免疫接种 调查。我们将探索PN 2.0检查表对组织变革和患者评估的影响 使用事前/事后调查的护理团队质量。次要结果包括诊断解决的时间和 开始治疗。在目标3中，我们将使用实施研究综合框架和 混合方法(过程评价、定性访谈、成本分析)，以评估《 学习卫生系统PN 2.0核对表战略。结果将对实施产生重要影响， 在美国移民医疗服务不足的社区肿瘤学环境中，PN的可持续性和可扩展性 语言上与世隔绝的中国人等人群接受了大部分癌症治疗。

Through the work of a well-established research partnership among the Chinese American Service League (CASL), Mercy Hospital & Medical Center (Mercy), and Northwestern University (NU), our team completed a trial evaluating a one-on-one patient navigation (PN) intervention for breast and cervical cancer tailored to Chicago’s Chinatown. Our completed trial and others have demonstrated that PN is effective in improving consistency of cancer care and addressing Social Determinants of Health (SDoH) among underserved populations. Unfortunately, current standard one-on-one PN is difficult to scale and sustain without intensive financial resources, which limits one-on-one cancer PN to a temporary “Band-Aid” for fragmented healthcare systems. We have an opportunity to apply our team’s lessons learned from our completed PN trial in order to create a paradigm shift in PN to produce systems change in cancer care delivery to meet the needs of underserved populations. To do so, we propose a learning health system PN 2.0 Checklist implementation strategy that scales implementation of PN across cancers and builds a sustainable team-based checklist that will support coordination and integration of SDoH-related efforts across community oncology and community social service settings. In Aim 1, we will employ a design-thinking framework of co-creation and iterative prototyping to develop the PN 2.0 Checklist, transforming one-on-one PN into a learning health system PN approach centered around a team-based checklist that leverages the PN evidence base and active participation of community oncology and community social service stakeholders. In Aim 2, through a Hybrid Type 2 randomized effectiveness- implementation pragmatic trial, we will compare the effectiveness (non-inferiority) of the PN 2.0 Checklist relative to one-on-one PN in resolving SDoH barriers and increasing patient receipt of clinical cancer preventive services. N=600 Chinese adults recruited from Chicago’s Chinatown will be randomized to standard one-on-one cancer PN (control) or cancer PN 2.0 Checklist (intervention). The primary outcome is an adjusted, composite proportion of SDoH barriers resolved and completion of U.S. Preventive Services Task Force recommended cancer-related screenings, behavioral counseling, and immunizations, collected via chart review and patient surveys. We will explore the effect of the PN 2.0 Checklist on organizational change and patient assessment of care team quality using pre/post surveys. Secondary outcomes include time to diagnostic resolution and time to treatment initiation. In Aim 3, we will use the Consolidated Framework for Implementation Research (CFIR) and mixed-methods (process evaluation, qualitative interviews, cost analysis) to evaluate the implementation of the learning health system PN 2.0 Checklist strategy. Results will have important implications for implementation, sustainability, and scaling of PN in community oncology settings where medically underserved U.S. immigrant populations, such as linguistically isolated Chinese, receive the bulk of their cancer care.