Increasing Cancer Screening Rates

Topic(s): Health Care Quality, Access to Health Care, Care Coordination
Geographic Location: Delaware
Health Center: La Red Health Center, Inc.
Date Posted: April 2019

The Role of Nurse Navigators in Preventative Care

The La Red Health Center, Inc., (LRHC) was founded by a group of physicians and community partners in 2001 to meet the increasingly complex health needs of the growing uninsured population in Sussex County, Delaware. In 2006, LRHC became a Health Resources and Services Administration (HRSA) funded health center and seven years later it gained Patient-Centered Medical Home (PCMH) recognition. HRSA’s PCMH initiative supports health centers working towards better care, lower costs for patients, and continuous quality improvement.

Recently, LRHC has achieved a number of clinical success outcomes, including increasing its cervical cancer screening rates from 72% to nearly 95% from 2016 to 2017, exceeding the National Healthy People 2020 goal of 93%. This improvement in screening rates earned LRHC a Clinical Quality Improver award in 2018 from HRSA. Quality Improvement Awards (QIAs) are one way that HRSA furthers its commitment to improving the overall quality, efficiency, and value of health care services at health centers across the country. LRHC staff developed new strategies to help patients access and receive care by reviewing and analyzing data on missed appointments, identifying barriers to maintaining these appointments, and hiring nurse navigators to help connect patients to care. This dedication from LRHC staff resulted in three QIAs in 2018 for a total of $74,027 in additional funding.

“We have two nurse navigators that are dedicated to patient outreach, scheduling appointments, and conducting follow-up with providers in order to increase compliance with recommended treatment plans. These nurses run reports daily on appointments looking for patients that have missed several appointments and patients that are scheduled in the next few weeks,” explained Brian Olson, LRHC’s Chief Executive Officer.

LRHC is located in an area of Delaware with a racially diverse, large immigrant, and increasingly senior population with limited access to public transportation and English proficiency, among other barriers to care.  All of these factors make accessing primary care challenging for the majority of their patients. “Our nurse navigators look at these barriers to care and work to meet the needs of our patients. From arranging transportation, setting up translation services, and even putting reminder notes for providers on patient charts, they do everything they can to help patients make and keep their appointments,” maintained Brenda Pusey, Director of Quality Improvement for LRHC.

Nurse navigators have been instrumental in helping LRHC improve its breast, cervical, and colorectal cancer screening rates. They analyze and track patient appointment data utilizing dashboards and proactively identify patients that have not had a preventative screening. For medical staff, the nurse navigators set up preventive screening reminders in the medical record and serve as the educator and coordinator for promoting preventative care. For patients, the nurse navigators set up transportation and translation services, conduct appointment reminders via phone and postcards, and schedule patients for appointments directly during community outreach events. These examples can help other HRSA funded health centers increase their preventive screening rates, deliver better care to their patients, and promote the Health Center Program mission.

Because of the preventive screening reminders in the medical record, during a visit the health care provider informs the patient that they should be screened and then directs the patient to a nurse navigator who meets with the patient for education and care coordination. These efforts improve the patient experience, as nurse navigators can take more time to discuss the screening procedure and assist patients in scheduling their follow-up appointment. Nurse navigators also work closely with data analysts and meet with the care team in daily interdisciplinary team huddles to proactively discuss and address patient needs. All of this information is then entered into dashboards that keep all staff informed of their progress towards the center’s goals.

“Having direct access to OB/GYN services has also been a catalyst for family practice and other primary care doctors to conduct screenings and make referrals to specialists,” indicated Rosa Rivera, LRHC Chief Operations Officer. LRHC’s nurse navigator program illustrates how analyzing patient data can lead to reducing patient care barriers and improving responsive care delivery. The health center has developed different methods of patient outreach, from public events to sending postcard appointment reminders, to help their patients improve their health.

For more information about LRHC and the efforts to improve cervical cancer screening, contact Brenda Pusey at 302-855-1233 extension 1118.

Date Last Reviewed:  April 2019