Advancing Innovations in Patient Navigation and Implementation Science

Northwestern University At Chicago, Evanston IL

Investigators

Abstract

SOCIAL DETERMINANTS OF HEALTH RESEARCH PROJECT – ABSTRACT Cancer is a leading cause of death in Chicago, and patient populations with low health access in Northwestern University’s catchment area communities face significant worsening cancer health outcomes. Many worsening cancer health outcomes are avoidable, and research is needed to address multifaceted determinants of health. Cancer patient navigation (PN) interventions have demonstrated efficacy in resolving patients’ barriers to care and improving completion and consistency of cancer care events, such as screening, follow-up, and treatment initiation among all populations. The evidence has contributed to the designation of PN as an evidence-based intervention. However, traditional cancer PN involves navigators working with patients on a case-by-case basis, serving as a “Band-Aid” – temporarily mitigating some effects of multilevel barriers to care – but rarely producing provider- and contextual-level change in cancer care delivery. Thus, we apply our experience from over a decade of PN research, in partnership with community-based organizations with deep roots in Chicago communities with low access to care, to develop and test novel multilevel PN approaches within Learning Health Systems that propel a potentially transformative new cancer PN paradigm where navigators have the tools to contribute to sustained provider- and systems level care improvements that address determinants of health and close cancer care delivery gaps at scale. Our PN innovations address key priorities identified by our ACCERT Center community partners and in accordance with the Center’s theme, will address social and contextual barriers to care, language accessibility, and health literacy, with the goal of mitigating worsening cancer health outcomes in Chicago. In Aim 1, we will employ community-engaged participatory design methods to refine two multilevel PN approaches: (1) remote PN augmented by interactive artificial intelligence (AI) agents that will automate certain PN tasks and support patient education and coaching; and (2) remote PN augmented with 4R Oncology (4R=Right Information and Right Treatment to the Right Patient at the Right Time) – a model which uses systems engineering principles and Care Sequences with checklists to facilitate systematic patient-facing care planning and team-based care delivery involving patients, providers of cancer care, social care and supportive care. In Aim 2, we will conduct a Hybrid Type 2 randomized effectiveness-implementation trial with N=735 adults from Chicago communities with low access to care to compare the effectiveness of the novel PN approaches relative to Standard PN in resolving barriers to care and improving patient receipt of cancer-related health services (patient-level outcome), improving patient-provider communications, reducing medical mistrust, and improving care quality in medical settings (patient/provider/health-systems level outcomes). In Aim 3, we use mixed methods to evaluate implementation outcomes and multilevel implementation determinants.