Study Protocol: A Randomized Controlled Trial of Patient Navigation-Activation to Reduce Cancer Health Disparities

Abstract Background Cancer health disparities affecting low-income and minority patients are well documented. Root-causes are multifactorial, including diagnostic and treatment delays, social and financial barriers, and poor communication. Patient navigation and communication coaching (activation) are potential interventions to address disparities in cancer treatment. The purpose of this clinical trial is to test the effectiveness of an intervention combining patient navigation and activation to improve cancer treatment. Methods/Design The Rochester Patient Navigation Research Program (PNRP) is a National Cancer Institute-sponsored, patient-level randomized trial (RCT) of patient navigation and activation, targeting newly-diagnosed breast and colorectal cancer patients in Rochester, NY. The goal of the program is to decrease cancer health disparities by addressing barriers to receipt of cancer care and promoting patient self-efficacy. The intervention uses trained, paraprofessional patient navigators recruited from the target community, and a detailed training and supervisory program. Recruited patients are randomly assigned to receive either usual care (except for baseline and follow-up questionnaires and interviews) or intervention. The intervention patients receive tailored assistance from their patient navigators, including phone calls, in-person meetings, and behind-the-scenes coordination of care. A total of 344 patients have been recruited. Outcomes measured at three month intervals include timeliness of care, patient adherence, patient satisfaction, quality of life, self-efficacy, health literacy, and cancer knowledge. Discussion This unique intervention combining patient navigation and patient activation is designed to address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of patient navigation programs. Trials Registration clinicaltrials.gov identifier NCT00496678http://deepblue.lib.umich.edu/bitstream/2027.42/78254/1/1471-2407-10-551.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78254/2/1471-2407-10-551.pdfPeer Reviewe

Planning a Better Future for Dual Eligible Elderly in Montgomery County

Older adults who are dual eligible (who qualify for both Medicare and Medicaid) face a daunting gauntlet of challenges in healthcare. Despite comprehensive coverage through Medicare and Medicaid, the lack of coordination between the two systems creates often insurmountable problems of access and delivery. Federally-funded Medicare lacks coordination and integration with federal-state funded Medicaid. Ironically, it is these dual eligible individuals who so desperately need healthcare since they have a higher incidence of cognitive impairment (including Alzheimer's Disease), mental disorders, diabetes, pulmonary disease and strokes. Further, they are more vulnerable and frail, have lower incomes, and are more isolated than are non-dual eligible elderly. These problems, in turn, contribute to significant challenges with housing, food and transportation. The challenges with access to care are tragic, expensive and avoidable.The high care needs of dual eligible individuals and the associated costs have driven states and the federalgovernment to seek ways to better integrate and coordinate their care. The Affordable Care Act (2010) is teemingwith initiatives, demonstrations, and new opportunities premised on finding a way to better meet dual eligibleindividuals' healthcare needs at a cost-effective rate. While little has yet been done at the state level, localproviders are starting to test innovative approaches to delivering better care to dual eligible individuals.This report summarizes state and federal initiatives and opportunities for delivering better care to dual eligible elderly. It also presents the efforts underway at the County level and by local providers. Following the informational section of the report, the Workgroup presents nine systems change recommendations to better improve the care provided to Montgomery County's dual eligible elderly. The recommendations may stand alone, each reflecting their own systems change, or may be combined in a more encompassing effort at service delivery system overhaul.There are numerous federal opportunities for delivering better care to frail populations. Some of them are specifically targeted towards the dual eligible population and others are targeted towards other populations, but include a considerable number of dual eligible individuals. In the report, we describe five different types ofapproaches and describe examples of each

Social Equity Impacts of Congestion Management Strategies

This white paper examines the social equity impacts of various congestion management strategies. The paper includes a comprehensive list of 30 congestion management strategies and a discussion of equity implications related to each strategy. The authors analyze existing literature and incorporate findings from 12 expert interviews from academic, non-governmental organization (NGO), public, and private sector respondents to strengthen results and fill gaps in understanding. The literature review applies the Spatial – Temporal – Economic – Physiological – Social (STEPS) Equity Framework (Shaheen et al., 2017) to identify impacts and classify whether social equity barriers are reduced, exacerbated, or both by a particular congestion mitigation measure. The congestion management strategies discussed are grouped into six main categories, including: 1) pricing, 2) parking and curb policies, 3) operational strategies, 4) infrastructure changes, 5) transportation services and strategies, and 6) conventional taxation. The findings show that the social equity impacts of certain congestion management strategies are not well understood, at present, and further empirical research is needed. Congestion mitigation measures have the potential to affect travel costs, commute times, housing, and accessibility in ways that are distinctly positive or negative for different populations. For these reasons, social equity implications of congestion management strategies should be understood and mitigated for in planning and implementation of these strategies

Arctic Vessel Traffic in the Bering Strait

This brief examines the risks posed by increasing vessel traffic and outlines a series of mitigation measures that authorities can implement to protect all those who depend on the Bering Strait—wildlife and indigenous communities, as well as ships and their crews

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Striving for Equity in Specialty Care Full Report

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.

Connecting Undergraduate Students as Partners in Computer Science Teaching and Research

Connecting undergraduate students as partners can lead to the enhancement of the undergraduate experience and allow students to see the different sides of the university. Such holistic perspectives may better inform academic career choices and postgraduate study. Furthermore, student involvement in course development has many potential benefits. This paper outlines a framework for connecting research and teaching within Computer Science- though this is applicable across other disciplines. Three case studies are considered to illustrate the approach. The first case study involves students in their honours’ stage (level 6, typically 3rd year) project, the second an undergraduate intern between stages 5 and 6, and finally, a MSc (level 7) project. All three case studies have actively involved students in core parts of the University’s teaching and research activities, producing usable software systems to support these efforts. We consider this as a continuing engagement process to enhance the undergraduate learning experience within Computer Science

Arizona: Round 1 - State-Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.A number of decisions helped set the stage for Arizona's implementation of the Affordable Care Act (ACA). These decisions and the dynamics that led to them reflect a complex mix of intergovernmental political calculation and pragmatic public policy, past and present, which frame the state's capacity for implementing ACA in Arizona

Peer Support for Addiction in the Inpatient Setting

Background: In 2006 the Institute of Medicine reported that combined mental illness and substance use disorder was the second leading cause of disability and death in women and the highest cause in men. More recent data obtained from the 2016 National Survey on Drug Use and Health (Ahrnsbratz et al 2016) indicates in 2016 only one in ten of the people who need treatment, receive it. At Cambridge Health Alliance’s Everett Hospital, the site of this pilot project, opioid overdose and acute alcohol intoxication comprise one in every ten visits in the Emergency Department. In January of 2018, CHA partnered with North Suffolk Mental Health to embed two Recovery Coaches in the Emergency Room and Inpatient setting to support and engagement and navigation into treatment for patients presenting to the hospital with addiction. Aims: The aim of this study is to describe Year One of the Recovery Coach pilot project, with recommendations for improvement to inform further program growth. Method: The population of patients who worked with a Recovery Coach in Year One is described in terms of demographic information, insurance status and ACO attribution. Semi-structured interviews of patients, Recovery coaches, staff, providers, and administrators were conducted to extract qualitative themes among the stakeholders. Results: The average patient is described as a 44-year-old, white, low-income, English-speaking male living in a surrounding community with Alcohol use Disorder. Themes emerging from interviews indicate positive support for the program from all stakeholder perspectives. Strong themes of value in patient engagement, Recovery Coach empowerment, and influence on staff and provider work satisfaction emerge, as well as several areas of opportunity for program improvement. Conclusions: The findings of this study provide valuable stakeholder input that will improve the program and inform its expansion. The findings should not be generalized to other programs, as the CHA inpatient-based Recovery Coach model is different than other programs described in the literature. However, this study may be of interest to another hospital planning to develop an inpatient-based model

An Indoor Navigation System Using a Sensor Fusion Scheme on Android Platform

With the development of wireless communication networks, smart phones have become a necessity for people’s daily lives, and they meet not only the needs of basic functions for users such as sending a message or making a phone call, but also the users’ demands for entertainment, surfing the Internet and socializing. Navigation functions have been commonly utilized, however the navigation function is often based on GPS (Global Positioning System) in outdoor environments, whereas a number of applications need to navigate indoors. This paper presents a system to achieve high accurate indoor navigation based on Android platform. To do this, we design a sensor fusion scheme for our system. We divide the system into three main modules: distance measurement module, orientation detection module and position update module. We use an efficient way to estimate the stride length and use step sensor to count steps in distance measurement module. For orientation detection module, in order to get the optimal result of orientation, we then introduce Kalman filter to de-noise the data collected from different sensors. In the last module, we combine the data from the previous modules and calculate the current location. Results of experiments show that our system works well and has high accuracy in indoor situations