County Health Rankings & Roadmaps, A Healthier Nation, County by County

Download Rankings Data

Get data for the entire nation or a state

Learn about the data & methods

Our Approach

Our model of population health

Ranking Methods

How Rankings are calculated

Using the Rankings Data

How to understand and go beyond the Rankings

Measuring Progress

Guide to understanding the health trends in your community

What can I do?

Action Center

Guides and tools for improving health

What Works for Health

Find effective policy/program strategies

What can I learn from others?

Community Grants

Local action to change policies or systems

National Partners

Learn about our partners in improving health

Stories

How communities are improving health

Projects Showcase

Examples of ways people are using the Rankings data

RWJF Culture of Health Prize

Learn about communities making a difference and how to apply

Systems navigators and integration (e.g., patient navigators)

Evidence Rating

Scientifically Supported

Health Factors

Patient navigators provide culturally sensitive assistance and care coordination, determining individual barriers and guiding patients through available medical, insurance, and social support systems. Navigators are usually employed by hospitals or clinics, and may be fully integrated into a primary care team. Hospitals and clinics generally try to hire patient navigators that come from the same communities as their patients. Currently, navigators are most commonly used in cancer care, often serving low income or disadvantaged patient populations.

Expected Beneficial Outcomes

  • Increased use of preventive services

  • Increased cancer screening

  • Improved birth outcomes

  • Improved maternal health

Evidence of Effectiveness

There is strong evidence that patient navigator programs increase rates of cancer screening, especially for breast cancer (Phillips 2010, ). Additional evidence is needed to confirm effects for programs focused on other health conditions and outcomes.

Patient navigators improve adherence to breast cancer screening recommendations, diagnosis follow-up, and treatment initiation (). Navigation can also increase screening rates for colorectal cancer (Jandorf 2005) and cervical cancer (), especially when implemented in conjunction with patient education (, Naylor 2012). Telephone support with patient navigation has been shown to be moderately effective in improving cancer care in minority populations (Naylor 2012, ). By increasing screening rates, patient navigator programs have the potential to reduce racial and socioeconomic disparities in early detection (, Phillips 2010, Jandorf 2005).

Patient navigator programs are suggested strategies to improve prenatal care (CDC-Reach, NACCHO-PNP), but, overall, have not been rigorously evaluated in this context. Such programs may help women navigate the Medicaid system, find managed care and a provider, and obtain other services such as food and transportation assistance (Payne 2011, NACCHO-PNP).

A study of three implementations of navigation programs indicates that patient navigation for breast and colorectal cancer can be cost-effective in community hospitals serving low income populations ().

Impact on Disparities

Likely to decrease disparities

Implementation Examples

The American Cancer Society’s Navigator program provides one-on-one guidance for cancer patients at many sites around the country (ACS Navigator). As of February 2012 the National Cancer Institute’s Patient Navigation Program included 17 pilot project sites (NCI-PNP). Section 3510 of the Affordable Care Act authorizes but does not appropriate funding for Patient Navigation Programs.

Some communities provide perinatal or prenatal navigators for at-risk women. The state of Maryland funds perinatal navigators (MD 2012), the CDC REACH US program at Virginia Commonwealth University provides prenatal navigators (CDC-Reach), and Pregnancy Partners in Clark County Washington assists low income women in accessing prenatal care during the first trimester (Payne 2011).

The Center for Patient Partnerships at the University of Wisconsin-Madison offers graduate, capstone, and professional certificates in Consumer Health Advocacy, intended to build skills in patient advocacy and knowledge of the health system. Coursework for the capstone and professional certificates can be completed entirely online (UW-CPP).

Implementation Resources

KCP-CPPNW 2009 - Kansas Cancer Partnership (KCP). Cancer patient navigation program toolkit (CPPNW). Topeka: Kansas Department of Health and Environment (KDHE); 2009.

Citations - Evidence

* Journal subscription may be required for access.

CDC-Reach - Centers for Disease Control and Prevention (CDC). Reach US Virginia Commonwealth University.

Payne 2011 - Payne M, Storey M, Sanders D. Pregnancy partners: A patient navigator system to improve early prenatal care. Washington State Journal of Public Health Practice. 2011;4(S1).

Robinson-White 2010* - Robinson-White S, Conroy B, Slavish KH, Rosenzweig M. Patient navigation in breast cancer: A systematic review. Cancer Nursing. 2010;33(2):127-40.

Phillips 2010 - Phillips CE, Rothstein JD, Beaver K, et al. Patient navigation to increase mammography screening among inner city women. Journal of General Internal Medicine. 2010;26(2):123-9.

NACCHO-PNP - National Association of County & City Health Officials (NACCHO). Patient navigator program.

Donaldson 2012* - Donaldson EA, Holtgrave DR, Duffin RA, et al. Patient navigation for breast and colorectal cancer in 3 community hospital settings: An economic evaluation. Cancer. 2012;118(19):4851-9.

Glick 2012* - Glick SB, Clarke AR, Blanchard A, Whitaker AK. Cervical cancer screening, diagnosis and treatment interventions for racial and ethnic minorities: A systematic review. Journal of General Internal Medicine. 2012;27(8):1016-32.

Naylor 2012 - Naylor K, Ward J, Polite BN. Interventions to improve care related to colorectal cancer among racial and ethnic minorities: A systematic review. Journal of General Internal Medicine. 2012;27(8):1033-46.

Jandorf 2005 - Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz SH. Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. Journal of Urban Health. 2005;82(2):216-24.

Citations - Implementation Examples

* Journal subscription may be required for access.

MD 2012 - Maryland.gov. Reduce infant mortality in Maryland by 10% by 2017.

CDC-Reach - Centers for Disease Control and Prevention (CDC). Reach US Virginia Commonwealth University.

Payne 2011 - Payne M, Storey M, Sanders D. Pregnancy partners: A patient navigator system to improve early prenatal care. Washington State Journal of Public Health Practice. 2011;4(S1).

NCI-PNP - Center to Reduce Cancer Health Disparities (CRCHD). PNP project listing. National Cancer Institute (NCI).

UW-CPP - Center for Patient Partnerships (CPP). Consumer health advocacy certificates: Overview & choosing a certificate.

ACS Navigator - American Cancer Society (ACS). American Cancer Society navigator.

Date Last Updated

Jul 11, 2013
  • Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
  • Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
  • Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
  • Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
  • Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
  • Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.