1
|
Matthews AK, Steffen AD, Burke LA, Donenberg G, Duangchan C, Akufo J, Opuada H, Oyaluade D, Vilona BH, Diaz H, Dodd D. The Use of Navigators to Increase Patient Portal Enrollment among Patients in a Federally Qualified Health Care System. Ethn Dis 2023; DECIPHeR:117-125. [PMID: 38846728 PMCID: PMC11099523 DOI: 10.18865/ed.decipher.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Purpose To describe the training, preliminary results, and lessons learned from using patient navigators to increase the enrollment of low-income patients in a health system-supported and electronic health record-linked patient portal. Methods Patient navigators (n=4) were trained to assist patients in a federally qualified health center to enroll in and use patient portals. Patient navigators were stationed at 3 clinic locations. Data from the electronic health record system (Epic) were used to compare MyChart patient portal activation rates and use among patients for the 8 months before and after patient navigation services were offered. Results Navigators offered 83% of eligible patients with activation assistance. Sixty-four percent of the patients (n=1062) offered MyChart enrollment assistance accepted help. Seventy-four percent of assisted patients with no prior MyChart enrollment activated their accounts during that clinic visit. The primary reason for declining MyChart assistance was a lack of access to or comfort with technology. Patient portal activation increased during the 8 months when navigators were at the clinics (51%) compared to the previous 8 months (44%). Most new users viewed lab results and read a message [χ2(1)=49.3, p<.001], with significant increases evident for African Americans [44% before, 49% during; χ2(1)=40.4, p<.001] and Latinx patients [52% before, 60% during; χ2(1)=6.15, p=.013]. Conclusion Study results suggest that using patient navigators is feasible and beneficial for increasing patient enrollment in the Federally Qualified Health Centers context. However, patient-, clinic-, and system-level factors were identified as barriers and should be addressed in future research studies.
Collapse
Affiliation(s)
| | | | - Larisa A. Burke
- College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Geri Donenberg
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | | | - Jennifer Akufo
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | - Hope Opuada
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | - Damilola Oyaluade
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | | | - Hilda Diaz
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | - Darcy Dodd
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| |
Collapse
|
2
|
Taylor KL, Webster MA, Philips JG, Whealan JM, Lobo T, Davis KM, Breece CJ, Wheeley JR, Childs JE, Le AQ, Williams RM, Veytsman IG, Kim C. Integrating Tobacco Use Assessment and Treatment in the Oncology Setting: Quality Improvement Results from the Georgetown Lombardi Smoking Treatment and Recovery Program. Curr Oncol 2023; 30:3755-3775. [PMID: 37185398 PMCID: PMC10136485 DOI: 10.3390/curroncol30040285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
As part of the NCI’s Cancer Center Cessation (C3i) initiative, we initiated, expanded, and maintained an evidence-based tobacco treatment program at the Georgetown Lombardi Comprehensive Cancer Center. We present a quality improvement (QI) assessment of the implementation process and patient-level outcomes. At two hematology/oncology outpatient clinical sites, five oncology-based teams (clinical administrators, clinical staff, pharmacy, information technology, and tobacco treatment staff) developed implementation strategies for opt-out patient assessment and enrollment, centralized tobacco treatment, audit, feedback, and staff training. Among eligible patients (tobacco use in ≤30 days), we assessed demographic, clinical, and tobacco-related characteristics to examine predictors of enrollment (baseline completed), treatment engagement (≥one sessions completed), and self-reported 7-day abstinence (6 months post-enrollment). Across both sites, medical assistants screened 19,344 (82.4%) patients for tobacco use, which identified 1345 (7.0%) current tobacco users, in addition to 213 clinician referrals. Of the 687/1256 (54.7%) eligible patients reached, 301 (43.8%) enrolled, and 199 (29.0%) engaged in treatment, of whom 74.5% were African American and 68% were female. At the larger site, significant multivariate predictors of enrollment included African American race (vs. white/other) and clinician referral (vs. MA assessment). Treatment engagement was predicted by greater nicotine dependence, and abstinence (27.4%) was predicted by greater treatment engagement. In summary, the systematic utilization of multiple oncology-based teams and implementation strategies resulted in the development and maintenance of a high-quality, population-based approach to tobacco treatment. Importantly, these strategies addressed inequities in tobacco treatment, as the program reached and engaged a majority-African-American patient population. Finally, the opt-out patient assessment strategy has been implemented in multiple oncology settings at MedStar Health through the Commission on Cancer’s Just Ask program.
Collapse
Affiliation(s)
- Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Marguerite A Webster
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Joanna G Philips
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Julia M Whealan
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Kimberly M Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
- Department of Psychiatry, Georgetown University Hospital, MedStar Health, Washington, DC 20007, USA
| | - Chavalia J Breece
- Department of Pulmonary Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, USA
- Department of Medical Oncology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Jennifer R Wheeley
- Department of Medical Oncology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Jack E Childs
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Ariel Q Le
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Irina G Veytsman
- Department of Medical Oncology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Chul Kim
- Department of Medicine, Georgetown University Medical Center, Division of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA
| |
Collapse
|
3
|
Use of Information and Communication Technology among Patients with Chronic Obstructive Pulmonary Disease Who Smoke: A Mixed Methods Study. Ann Am Thorac Soc 2023; 20:381-389. [PMID: 36351079 DOI: 10.1513/annalsats.202208-740oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Rationale: Although overall use is on the rise, certain patient populations have persistently low technology use. Objectives: To inform the creation of a proactive tobacco treatment program, we assessed access to, use of, and barriers surrounding information and communication technology (ICT) among patients with chronic obstructive pulmonary disease (COPD) who currently smoke, examining associations between key predictors and electronic health (e-health) literacy. Methods: Single-center mixed-methods study of veterans with COPD who smoke. Eligible participants who smoked were identified by the e-health record and mailed a survey. E-health literacy was assessed by the eHEALS (Electronic Health Literacy Scale; 8-40). Low technology use was defined as no Internet-capable device and use of ICT less than monthly. Qualitative participants were purposively selected from survey respondents and interviewed using a semistructured guide. Interviews were transcribed and analyzed using directed content analysis. We used a Bayesian three-component joint model to identify predictors of low technology use and low eHEALS. Results: Participants (N = 204) were older (mean age, 65.8), primarily White (76.4%), men (87.1%), and with low income (44.9% income under $20,000). Low technology use was reported by 25.5%, and many reported low use of specific types of ICT. For example, only 36.3% had reliable in-home Internet, fewer than half (46.6%) accessed e-mail at least weekly, 58.3% texted at least weekly, and few used the secure patient portal (13.2% accessed it monthly). The mean eHEALS was 24.6 (±8.7), indicating low to moderate e-health literacy. In the Bayesian analysis, low technology use was associated with lower eHEALS (estimate: -8.5 [95% confidence interval, -12.13 to -4.81]). Attainment of at least a college graduate-level education was associated with higher eHEALS (3.83 [0.43-7.24]). Participants reported barriers to use of ICT, including struggles navigating account security, frequently lost login information, mistrust of providing personal information to the Internet, and lack of familiarity with processes. Many perceived ICT as not useful or necessary. Conclusions: Many patients with COPD who smoke report barriers to engagement with health promotion programs offered electronically, which may perpetuate health disparities. Health promotion programs must account for the low use of ICT and e-health literacy to ensure equitable access across the population.
Collapse
|
4
|
Goshe BM, Rasmussen AW, Wagner LI, Sicks JD, Gareen IF, Carlos RC, Herman BA, Walter AW, Regan S, Levy DE, Mahon I, Muzikansky A, Neil JM, Lui M, Dilip D, Malloy L, Gonzalez I, Finkelstein-Fox L, McCann C, Perez E, Ostroff JS, Park ER. Study protocol for a hybrid type 1 effectiveness-implementation trial testing virtual tobacco treatment in oncology practices [Smokefree Support Study 2.0]. BMC Public Health 2022; 22:1359. [PMID: 35841024 PMCID: PMC9284951 DOI: 10.1186/s12889-022-13631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings. METHODS/DESIGN This two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes. DISCUSSION This trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery. TRIAL REGISTRATION ClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.
Collapse
Affiliation(s)
- Brett M. Goshe
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Autumn W. Rasmussen
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Lynne I. Wagner
- grid.241167.70000 0001 2185 3318Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - JoRean D. Sicks
- grid.40263.330000 0004 1936 9094ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI USA
| | - Ilana F. Gareen
- grid.40263.330000 0004 1936 9094Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, RI USA
| | - Ruth C. Carlos
- grid.214458.e0000000086837370Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Benjamin A. Herman
- grid.40263.330000 0004 1936 9094ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI USA
| | - Angela Wangari Walter
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.225262.30000 0000 9620 1122Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA USA
| | - Susan Regan
- grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Douglas E. Levy
- grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Irene Mahon
- grid.417949.60000 0004 0638 1385 ECOG-ACRIN Cancer Research Group, American College of Radiology, Philadelphia, PA USA
| | - Alona Muzikansky
- grid.32224.350000 0004 0386 9924Biostatistics Center, Massachusetts General Hospital, Boston, MA USA
| | - Jordan M. Neil
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.266902.90000 0001 2179 3618Department of Family and Preventative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Michelle Lui
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Deepika Dilip
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Laura Malloy
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Irina Gonzalez
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Lucy Finkelstein-Fox
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Caitlin McCann
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Elissa Perez
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Jamie S. Ostroff
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Elyse R. Park
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| |
Collapse
|
5
|
Taylor KL, Williams RM, Li T, Luta G, Smith L, Davis KM, Stanton C, Niaura R, Abrams D, Lobo T, Mandelblatt J, Jayasekera J, Meza R, Jeon J, Cao P, Anderson ED. A Randomized Trial of Telephone-Based Smoking Cessation Treatment in the Lung Cancer Screening Setting. J Natl Cancer Inst 2022; 114:1410-1419. [PMID: 35818122 DOI: 10.1093/jnci/djac127] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lung cancer mortality is reduced via low-dose CT screening and treatment of early-stage disease. Evidence-based smoking cessation treatment in the lung screening setting can further reduce mortality. We report the results of a cessation trial from the NCI's SCALE collaboration. METHODS Eligible patients (N = 818) aged 50-80 were randomized (May 2017-January 2021) to the Intensive vs. Minimal arms (8 vs. 3 phone sessions plus 8 vs. 2 weeks of nicotine patches, respectively). Bio-verified (primary) and self-reported 7-day abstinence rates were assessed 3-, 6-, and 12-months post-randomization. Logistic regression analyses evaluated the effects of study arm. All statistical tests were two-sided. RESULTS Participants reported 48.0 (SD = 17.2) pack-years and 51.6% were not ready to quit in < 30 days. Self-reported 3-month quit rates were significantly higher in the Intensive vs. Minimal arm (14.3% vs. 7.9%; OR = 2.00, 95% confidence interval [CI] = 1.26,3.18). Bio-verified abstinence was lower but with similar relative differences between arms (9.1% vs. 3.9%; OR = 2.70, 95% CI = 1.44, 5.08). Compared to the Minimal arm, the Intensive arm was more effective among those with greater nicotine dependence (OR = 3.47, 95% CI = 1.55, 7.76), normal screening results (OR = 2.58, 95% CI = 1.32, 5.03), high engagement in counseling (OR = 3.03, 95% CI = 1.50, 6.14) and patch use (OR = 2.81, 95% CI = 1.39, 5.68). Abstinence rates did not differ significantly between arms at 6-months (OR = 1.2, 95% CI = 0.68, 2.11) or 12-months (OR = 1.4, 95% CI = 0.82, 2.42). CONCLUSIONS Delivering intensive telephone counseling and nicotine replacement with lung screening is an effective strategy to increase short-term smoking cessation. Methods to maintain short-term effects are needed. Even with modest quit rates, integrating cessation treatment into lung screening programs may have a large impact on tobacco-related mortality.
Collapse
Affiliation(s)
- Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kimberly M Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | | | - Raymond Niaura
- School of Global Public Health, New York University, NY, NY, USA
| | - David Abrams
- School of Global Public Health, New York University, NY, NY, USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jeanne Mandelblatt
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jinani Jayasekera
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Eric D Anderson
- Department of Pulmonary and Sleep Medicine, Georgetown University Medical Center, Washington, DC, USA
| | | |
Collapse
|