Table 1.
Description of the multilevel context for ACCSIS patient navigation components
| Characteristics | Appalachia | Arizona | Chicago | New Mexico | North Carolina | Oklahoma | Oregon | San Diego |
|---|---|---|---|---|---|---|---|---|
| Funding years | ||||||||
| Funding years | 2019-2023 | 2019-2023 | 2019-2023 | 2019-2023 | 2019-2023 | 2019-2023 | 2020-2024 | 2020-2024 |
| Geographic regions served | ||||||||
| Geographic regions served | 12 Appalachian counties in OH and KY | Largely rural AI communities in AZ | Cook County, IL; northern IN | Largely rural AI communities in Albuquerque area Southwest Tribal Epidemiology Center service area (NM and TX) | Northeastern and western NC | Rural southeastern and western OK and urban Oklahoma City | Rural and frontier communities in OR | San Diego County, CA |
| Health system characteristics | ||||||||
| Health system | 10 rural clinics | 5 clinics (2 urban FQHC clinics, 3 IHS clinics) | 4 health systems (43 clinics) | 4 tribally operated clinics | 2 FQHCs (16 clinics) | 6 IHS/tribal/urban AI clinics | 3 Medicaid health plans and 29 clinics (12 rural health clinics, 11 with no federal designation, 5 FQHC clinics, 1 tribal clinic) located in rural regions | 3 FQHCs (9 clinics) and 1 centralized hub in urban and rural regions |
| Health system resources | Charity funds, hospital funding, HRSA funding, referral clerks for scheduling colonoscopy | PNs, support staff, appointment reminders, EHR notifications, limited transportation services | Case management/care coordination team | Transportation services, appointment reminders, education, social support, interpretation | EHR queries; quality improvement team; hospital financial assistance; limited local transportation services (in 1 FQHC) | Clinic case managers, referral specialists, colonoscopy provided at IHS/tribal hospitals; primary care and tribal partners assist with transportation costs when needed | Health plan navigators will serve as backup for clinics, transportation benefit for Medicaid enrollees, low-cost colonoscopy services vary by clinic | Referral staff, physician prompts, EHR queries |
| Demographic characteristics of population served by navigationa | ||||||||
| Sexa | ||||||||
| Median % female (range) | 51.5 (50-53) | 59 (—) | 59 (57-60) | 50 (—) | 58 (58-58) | 56 (43-60) | 53 (49-55) | 59 (59-60) |
| Insurance statusa | ||||||||
| Median % uninsured (range) | 2.5 (2-33) | — | 17 (10-31) | 30 (—) | 23.5 (10-37) | 29 (—) | 0 (0-0) | 20 (15-26) |
| Median % Medicaid (range) | 31.5 (1-54) | — | 56 (55-65) | 70 (—) | 8 (6-10) | 10 (—) | 100 (100-100) | 60 (58-74) |
| Race/ethnicitya | ||||||||
| Median % Non-Hispanic White (range) | 99 (99-99) | 0 (0-0) | 37 (8-56) | 0 (0-0) | 53.5 (40-67) | 0 (0-0) | 93 (92-94) | 30 (25-43) |
| Median % Hispanic American (range) | 0 (0-0) | 0 (0-0) | 30 (10-37) | 0 (0-0) | 5.7 (0.4-11) | 0 (0-0) | 5 (4-7) | 60 (54-77) |
| Median % Black/African American (range) | 0 (0-0) | 0 (0-0) | 45 (18-66) | 0 (0-0) | 30 (5-55) | 0 (0-0) | 1 (0-2) | 5 (3-22) |
| Median % Asian American (range) | 0 (0-0) | 0 (0-0) | 1 (1-2) | 0 (0-0) | 0.35 (0.3-0.4) | 0 (0-0) | 2 (1-2) | 6 (3-17) |
| Median % American Indian (range) | 0 (0-0) | 100 (100-100) | 0.5 (0-1) | 100 (100, 100) | 0.25 (0.2, 0.3) | 100 (100, 100) | 3 (2, 4) | 1 (0,3, 1.0) |
| Colonoscopy providers | ||||||||
| No. referring colonoscopy facilities | 33 | 10-15 | 10-20 | 8 | 5-6 | 5 | ∼20 | 20-30 |
| Partnerships with colonoscopy providers | N/A | N/A | N/A | N/A | Reduced-cost colonoscopy services available ($500) at 1 FQHC for uninsured patients; fee covers provider-donated colonoscopy, preprocedure visit, anesthesia, pathology. | Tribal facilities (n = 3) and IHS facility (n = 1) provide bowel prep, colonoscopy free of charge to AI patients. Private GI practice (n = 1) charges standard rates for prep, colonoscopy. | Most providers are primary care providers trained to perform colonoscopies. | Reduced-cost colonoscopy services available ($800) and free colonoscopy services sometimes available through special programs |
| Community resources | ||||||||
| Transportation services, limited | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Free/low-cost screening or follow-up, limited | Yes | No | Yes | Yes | Yes | No | Yes | Yes |
| Overnight housing | No | Yes | No | No | No | Yes | No | No |
| Other | No | No | No | Educational materials, reminders for screening, social support | Interpretation services | Public service announcements (print, social media); community-based FIT distribution | No | No |
| Policy context | ||||||||
| Relevant certifications/reimbursement | No certification requirements and no reimbursement for patient navigation services in KY or OH | No certification requirements and no reimbursement for patient navigation services | No certification requirements and no reimbursement for patient navigation services | Most community health workers certified by state departments of health and receive CEUs for attending trainings sponsored by study team | No certification requirements and no reimbursement for patient navigation services | No certification requirements: community health workers/navigators receive CEUs for attending trainings held in NM. | Certification offered to community health workers who can bill for 1-on-1 patient education; value-based payment, and capitated payment for patient-centered medical home status may help fund these roles. | No certification requirements and no reimbursement for patient navigation services in CA |
a
Medians and ranges are reported at the health plan-level for Oregon, at the helath center-level for San Diego, Chicago, and North Carolina, and at the clinic-level for Appalachia, Arizona, New Mexico, and Oklahoma. Medians and ranges were unavailable for some patient characteristics for Arizona, New Mexico, and Oklahoma. ACCSIS = Accelerating Colorectal Cancer Screening and Follow-Up Through Implementation Science; AI = American Indian; FQHC = Federally Qualified Health Center; IHS = Indian Health Service; HRSA = Health Resources and Services Administration; PN = patient navigator; EHR = electronic health record; GI = gastroenterology; CEUs = continuing education units.