Dissemination of Patient Navigation Programs Across the United States Nancy Hedlund, MBA, RPh; Betsy C. Risendal, PhD; Heather Pauls, BA; Patricia A. Valverde, MPH; Elizabeth Whitley, PhD, RN; Angelina Esparza, MPH, RN; Emily Stiehl, PhD; Elizabeth Calhoun, PhD, MEd  Objective: To use diffusion and dissemination frameworks to describe how indicators of economic and health care disparity affect the location and type of patient navigation programs. Methods: A cross-sectional national Web-based survey conducted during 2009-2010 with support from 65 separate national and regional stakeholder organizations. Participants: A total of 1116 self-identified patient navigators across the United States. Main Outcome Measure: The location and characteristics of patient navigation programs according to economic and health care disparity indicators. Results: Patient navigation programs appear to be geographically dispersed across the United States. Program differences were observed in navigator type, population served, and setting by poverty level. Programs in high-poverty versus low-poverty areas were more likely to use lay navigators (P < .001) and to be located in community health centers and agencies with religious affiliations (50.6 vs 36.4%, and 21.5% vs 16.7%. respectively; P ≤ 0.01). Conclusion(s): Results suggest that navigation programs have spread beyond initial target inception areas and also serve as a potentially important resource in communities with higher levels of poverty and/or relatively low access to care. In addition, while nurse navigators have emerged as a significant component of the patient navigation workforce, lay health navigators serve a vital role in underserved communities. Other factors from dissemination frameworks may influence the spread of navigation and provide useful insights to support the dissemination of programs to areas of high need. KEY WORDS: access, disparity, patient navigator, poverty, zip code J Public Health Management Practice, 2014, 20(4), E15–E24 Copyright C  2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient navigation has emerged over the past 2 decades as an important strategy for reducing health disparities in the United States. 1 Health disparities are defined by the National Institutes of Health as, differences in the burden of disease as evidenced by disparities in incidence, prevalence, and mortality rates among specific groups. 2 Such disparities result not only in excess rates of disease and human suffering for individuals but also impose indirect costs on both public programs and purchasers of private health insurance. The Urban Institute estimates that over the 10-year period from 2009 to 2018, health disparities will cost the US health care system approximately $337 billion, as the proportion of elderly Latinos and African Americans increases. 3 The role of a patient navigator is to provide indi- vidualized assistance to vulnerable patients in order to overcome barriers and facilitate timely access to care. Patient navigators’ ability to address health disparities is well-recognized, especially in the context of improv- ing the uptake and follow-through of cancer-related screenings. 4 For example, navigation has been shown to reduce the time interval between an initial abnormal test result and the follow-up diagnostic resolution and initiation of treatment, where malignancy is diagnosed. 5-13 Those most at risk for advanced stage Author Affiliations: University of Illinois at Chicago (Mss Hedlund and Pauls and Drs Stiehl and Calhoun); Colorado School of Public Health, University of Colorado Denver (Dr Risendal and Ms Valverde), Denver Health, Denver, Colorado (Dr Whitley); and American Cancer Society, Atlanta, Georgia (Ms Esparza). This study was funded by NCI 5 U01 CA 116903. The authors thank Richard Barrett, PhD, for guidance with geolytical exploration techniques. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.JPHMP.com). The authors declare no conflicts of interest. Correspondence: Nancy Hedlund, MBA, RPh, School of Public Health, Univer- sity of Illinois at Chicago, 1603 W Taylor St, Chicago, IL 60612 (Nhedlu2@uic.edu mailto). DOI: 10.1097/PHH.0b013e3182a505ec Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. E15