Outcomes and cost of patient navigation in increasing colorectal cancer screening in a safety net hospital-based health center.

purposeTo assess the screening outcomes and cost of patient navigation (PN) to improve colorectal cancer (CRC) screening uptake of stool-based tests and colonoscopies in a safety net setting.

methodsWe conducted a quantitative assessment of a PN program at MedStar, a nonprofit hospital system based in the Washington, DC area. We collected and analyzed data for the 2023 calendar year on sociodemographic characteristics of patients, screening test completion, barriers to screening, and the labor and non-labor costs of the PN program. The main outcome measures for this study included the number of patients navigated, overall screening uptake and follow-up procedure completion rates. We also calculated the cost of the PN program, the average cost per person navigated, and the cost per patient who completed a screening or follow-up procedure.

resultsMedStar's PN program navigated 1,287 patients, of whom 77.5% were reached and 43.5% completed screening or follow-up procedures. Another 20.9% of persons navigated were still in the process of completing screening or follow-up colonoscopies (e.g., awaiting appointments). The most common barriers reported were challenges related to bowel preparation (25.3%) and comorbidities (13.7%). The average cost per person to deliver navigation was $209.83, while the average cost per patient successfully navigated to complete procedures was $482.23.

conclusionPN is effective in increasing CRC screening and follow-up and this improvement can be achieved at a reasonable cost in safety net settings. Future research should investigate approaches to reach all patients referred for navigation and optimal approaches to address patient barriers.