. 2023 Feb 22;115(6):680–694. doi: 10.1093/jnci/djad032

Table 2.

Characteristics of ACCSIS patient navigation programs

Characteristics	Appalachia	Arizona^a	Chicago	New Mexico^a	North Carolina	Oklahoma^a	Oregon	San Diego
Patient selection criteria
Eligibility for patient navigation^b	Medically underserved adults	AI health system patients	Racial/ethnic minority and low-income populations	AI patients served by tribally operated health systems	Adults served by 1 of 2 partnering health systems	AI health system patients	Medicaid and dual (Medicaid-Medicare) recipients	Insured adults, served by 1 of 3 health systems
Age, y	50-74	50-75	50-74	50-75	50-74	50-75	50-75	50-75
Due for CRC screening	Yes	Yes	Yes	Yes	No	Yes	No	No
Due for follow-up to an abnormal stool-based test	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Intervention selection
Previously published or newly developed protocol	Newly developed program or modification of existing program	Existing National Cancer Institute-funded navigation program, adapted to AI population (13)	New program and/or modifications of existing infrastructure (ie, text messaging)	Newly developed	Newly developed PN program informed by previous work and work of Newcomer (NC) and Pignone (TX) (42); PN protocols adapted from protocols developed by Dr Lynn Butterly (43)	Newly developed	Adapted PN program developed by Dr Lynn Butterly (43)	Based on previous work, scaled-up version (24)
Informed consent	Waived	Waived	Waived	Waived	Partially waived, verbal assent required	Waived	Waived	Waived
Intervention characteristics
Program target
CRC screening	Yes	Yes	Yes	Yes	No	Yes	No	No
Follow-up to abnormal stool test	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Referral to care (as needed)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Anticipated no. patients to receive navigation (estimate)	3000 per year (150 per month [KY], 100 per month [OH])	∼350 per year	720 per year (60-80 per month)	1300 per year (100 per month for CRC screening, 50-100 per year for follow-up colonoscopy)	40-50 per year (80 abnormal stool-test results FIT+ expected over 2 y)	2600 per year (200 per month for CRC screening, 15-20 per month for follow-up colonoscopy)	25 per year	100 per year
Topic areas	Identification, tracking, follow-up (5 clinics); identification, barrier assessment, tracking, follow-up (5 clinics)	Primarily phone-based navigation; reminders to complete FIT and/or abnormal FIT follow-up; assessment of barriers; education/outreach; interpretation; tracking of activities	Phone-based navigation: Step 1: Identification of patient (fail to complete screening after 60 d) Step 2: First phone call to assess barriers and social needs, provide education as needed Step 3: Barrier resolutions Step 4 (Specific for colonoscopy): education on bowel prep Step 5: Colonoscopy check-in Step 6: Follow-up results (1 wk after FIT, 2-4 wk after colonoscopy)	Primarily phone-based navigation; reminders to complete FIT and/or abnormal FIT follow-up; assessment of barriers; education/outreach; interpretation; tracking of activities	4-5 call protocol Call 1: Introduction and initial barrier assessment, schedule plans Call 1.5: Quick check-in to confirm whether patients are scheduled Call 2: Review prep and reassess barriers Call 3: Final preprocedure check-in, final barrier assessment Call 4: Postprocedure check-in to review results and answer any remaining questions	Primarily phone-based navigation; reminders to complete FIT and/or abnormal FIT follow-up; assessment of barriers; education/outreach; interpretation; tracking of activities	4-topic protocol Topic 1: First call and barrier assessment (within 30 d of navigator assignment) Topic 2: Bowel prep review (7 d before colonoscopy) Topic 3: Colonoscopy check-in (day before colonoscopy) Topic 4: Colonoscopy results (1–2 wk after colonoscopy)	Phone-based navigation; abnormal FIT follow-up; assessment of barriers; assistance with colonoscopy prep and scheduling; assistance with appointment reminders and follow-up; assistance with understanding diagnosis and cancer treatment, if needed; tracking of activities
Timing of program enrollment/initial patient navigator contact
Immediately upon determination of eligibility	Yes	Yes	No, 1 wk after screening order through SMS; Phone navigation: 2 mo following stool test order or 3 mo following referral to colonoscopy	Yes	Yes	Yes	Yes	Yes
Patient identification/eligibility confirmation	EHR query (for CRC screening and follow-up) followed by manual scrub; also monitor annual wellness visit lists	EHR query and clinic scheduling system	EHR query or population management tool	EHR query	EHR query, followed by manual scrub of CRC results at 1 clinic, eligibility confirmation via intro letter with study information allowing patients to self-report screening history	EHR query	Manual review of FIT results (of enrollees included in annual mailed FIT program); clinic staff confirm eligibility	EHR query
Introduction letter sent?	No	No	No	No	Yes	No	No	No
Delivery platforms
Phone	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes
In-person	Yes	Yes	No	No	No	No	No	No
Mail	Yes	No	Yes	Yes	Yes	Yes	No	No
Text	No	No	Yes	No	No	Yes	No	No
Patient contacts (no. attempts)	At least 2 attempts	From 1 (if person declines/requests no more contact) to 6 before lost to follow-up	2 phone calls and postcard for FIT/screening colonoscopy	Up to 5 call attempts	∼4 calls for navigated patients, ∼3 attempts for unable to reach and/or lost to follow-up	∼3 calls or mailings; varies by clinic	Determined by clinic	At least 5 attempts
Close-out letter sent for not reached, declined, or lost to follow-up (programmatically)?	Yes	No	No	No	Yes	No	No, but clinics can opt to send close out letter as part of standard care	No, recorded in EHR as unable to notify/locate patients who need abnormal FIT follow-up
Practitioners
No. navigators	16 (9 clinics have 1 PN, 1 clinic has 7 PNs)	5 (1 per site) funded by the grant	4 (1 per health system) plus text-based client reminder and education system	6-8 PNs trained per clinic, at least 2 deployed per clinic	1 + 1 back-up PN, centralized	10 trained, 5 deployed (1 system with 3 clinics has 1 PN, 1 system with 2 clinics has 1 PN, 1 system with 1 clinic has 1 PN; 2 PNs work on community outreach for all study clinics)	31 (∼2 per clinic) plus 1 back-up navigator (at health plan-level) trained; 6 deployed	3 (1 per health system)
Professional license required?	No	No	No	No	No	No	No	No
Experience required for PN role?	No	No	Case management experience	No	No, but experience preferred	No	No	Yes. Associate degree in related field plus 3 y relevant experience
Typical licensure/experience/position	Case managers, population health nurses, nurse navigators, health coach	CHWs and clinic staff	Case managers, CHWs	Medical assistants, nurses, nurse practitioners, CHRs, public health nurses, nursing assistants, health educators	N/A	Registered nurses, licensed practical nurses, or community health educators	Clinic manager, registered nurse, medical assistant, CHW	CHW, medical assistant, case manager, health educator, PN
Navigators’ employer	Health system	Clinic	Partner health systems (traditional PN) and by university for text-based navigation	Tribes and tribally operated clinics	Academic cancer center employee using ACCSIS research funds	IHS/tribal/urban Indian clinic facility; 2 PNs employed by OK University College of Nursing serve as hub for all PNs	Clinic or health plan	Clinics
% FTE dedicated to navigation	5%-100%	100%	5%-50%	25%	100%	100%	<5%	100%
Data tracking systems used (for navigation)
Research-specific database (REDCap or Excel)	Yes (1 clinic)	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Other	No	No	Yes, EHR reports; automated text message reminder platform	Yes, lab logs	No	No	Yes, Medicaid claims data	No

All tribal members can access health-care services at the tribally operated health-care facilities; some clinic sites are tribally operated and thus are part of the community. AI = American Indian; CRC = colorectal cancer; PN = patient navigator; FIT = fecal immunochemical test; SMS = short message service; EHR = electronic health record; CHW = community health worker; CHR = community health representative; ACCSIS = Accelerating Colorectal Cancer Screening and Follow-Up Through Implementation Science; IHS = Indian Health Service; FTE = full-time equivalent.

Eligibility criteria were modified for some programs to align with 2021 US Preventive Services Task Force recommendation to initiate CRC screening at age 45 years.