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Varanasi AP, Burhansstipanov L, Dorn C, Gentry S, Capossela MA, Fox K, Wilson D, Tanjasiri S, Odumosu O, Saavedra Ferrer EL. Patient navigation job roles by levels of experience: Workforce Development Task Group, National Navigation Roundtable. Cancer 2024; 130:1549-1567. [PMID: 38306297 DOI: 10.1002/cncr.35147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
PLAIN LANGUAGE SUMMARY Cancer patient navigators work in diverse settings ranging from community-based programs to comprehensive cancer centers to improve outcomes in underserved populations by eliminating barriers to timely cancer prevention, early detection, diagnosis, treatment, and survivorship in a culturally appropriate and competent manner. This article clarifies the roles and responsibilities of Entry, Intermediate, and Advanced level cancer patient navigators. The competencies described in this article apply to patient navigators, nurse navigators, and social work navigators. This article provides a resource for administrators to create job descriptions for navigators with specific levels of expertise and for patient navigators to advance their oncology careers and attain a higher level of expertise.
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Affiliation(s)
| | | | - Carrie Dorn
- National Association of Social Workers, Washington, DC, USA
| | - Sharon Gentry
- Academy of Oncology Nurse and Patient Navigators (AONN+), Lewisville, North Carolina, USA
| | | | - Kyandra Fox
- Patient Navigation, Education and Training, Susan G. Komen Foundation, Allen, Texas, USA
| | - Donna Wilson
- HCA Henrico Doctors' Hospital/Virginia Cancer Patient Navigator Network (VaCPNN), Midlothian, Virginia, USA
| | - Sora Tanjasiri
- Department of Health, Society and Behavior, University of Irvine, Irvine, California, USA
| | | | - Elba L Saavedra Ferrer
- College of Education and Human Sciences, University of New Mexico, Albuquerque, New Mexico, USA
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Pasquini TLS, Goff SL, Whitehill JM. Navigating the U.S. health insurance landscape for children with rare diseases: a qualitative study of parents' experiences. Orphanet J Rare Dis 2021; 16:313. [PMID: 34266466 PMCID: PMC8281562 DOI: 10.1186/s13023-021-01943-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents of children with rare diseases often face uncertainty about diagnosis, treatment, and costs associated with healthcare for their child. Health insurance status impacts each of these areas, but no U.S. study has explored parents' perceptions of the health insurance impacts on their child's care. This study aimed to qualitatively explore how these parents navigate the complex health insurance system for their children and their experiences in doing so. METHODS Semi-structured interviews were conducted with parents of children with metachromatic leukodystrophy (MLD) and spinal muscular atrophy (SMA), chosen for specific disease characteristics and orphan drug status. Participants were recruited via e-mail through patient advocacy organizations between September and December 2018. Interviews were conducted via Skype, were recorded, and professionally transcribed. Modified grounded theory was utilized as a methodology to analyze transcripts in an iterative process to determine themes and sub-themes based on participant described experiences. RESULTS Major themes and subthemes that emerged across the 15 interviews included: (1) difficulties obtaining secondary insurance based on state eligibility criteria; (2) difficulty accessing needed healthcare services; and (3) need for repeated interactions with insurance representatives. The absence of clearly documented or widely recognized clinical guidelines exacerbated the difficulty accessing care identified as necessary by their healthcare team, such as therapy and equipment. An explanatory model for parent's experiences was developed from the themes and subthemes. The model includes the cyclical nature of interacting with insurance for redundant reauthorizations and the outside support and financial assistance that is often necessary to address their child's healthcare needs. CONCLUSIONS With complex health conditions, small setbacks can become costly and disruptive to the health of the child and the life of the family. This study suggests that patients with rare diseases may benefit from time limits for processing coverage decisions, increasing transparency in the claims and preauthorization processes, and more expansive authorizations for on-going needs. Additional studies are needed to understand the full scope of barriers and to inform policies that can facilitate better access for families living with rare diseases.
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Affiliation(s)
- Tai L. S. Pasquini
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA United States
- Congenital Hyperinsulinism International, P.O. Box 135, Glen Ridge, NJ 07028 USA
| | - Sarah L. Goff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA United States
| | - Jennifer M. Whitehill
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA United States
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Dahlem CHG, Scalera M, Anderson G, Tasker M, Ploutz-Snyder R, McCabe SE, Boyd CJ. Recovery opioid overdose team (ROOT) pilot program evaluation: A community-wide post-overdose response strategy. Subst Abus 2020; 42:423-427. [PMID: 33284095 DOI: 10.1080/08897077.2020.1847239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Effective interventions for overdose survivors are needed in the emergency departments (EDs). One promising model is the use of peer recovery coaches to engage with survivors in EDs, followed by partnering with community case management navigators to connect survivors to recovery support and treatment services. This paper describes the evaluation of a pilot program, the Recovery Opioid Overdose Team (ROOT), a warm hand-off system that links survivors to treatment services post-ED discharge. Methods: The ROOT program is composed of a peer recovery coach who is in long-term recovery, and a case management navigator who specializes in mental health care and provides guidance for accessing community services. After an overdose reversal, law enforcement contacts a county 24/7 Crisis Team, who then notifies ROOT. The peer recovery coach engages with the survivor in the ED, and then follow up continues with the case management navigator and the peer recovery coach for up to 90 days post-ED discharge. Retrospective chart reviews were conducted to evaluate ROOT in two Midwest EDs from September 2017 through March 2019. Results: Of the 122 referrals, 77.0% (n = 94) of the survivors initially engaged with ROOT in the ED or in the community. The remaining 23.0% (n = 28) left the ED against medical advice or were unengaged. The majority of overdose survivors were male (63.9%; n = 78), White (43.4%; n = 53), had housing (80.2%; n = 48), and access to transportation (48.4%; n = 59). From the 122 referrals, 33.6% (n = 41) received ongoing treatment services (n = 20 outpatient, n = 17 residential, n = 2 detoxification facility, n = 1 recovery housing, n = 1 medication treatment for opioid use disorder), 2.5% (n = 3) were incarcerated, 2.5% (n = 3) died, and 61.5% (n = 75) declined services. Conclusions: The ROOT, a community-wide coordinated program in the EDs, shows promise in linking overdose survivors to recovery support and treatment services post-overdose.
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Affiliation(s)
- Chin Hwa Gina Dahlem
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | | | | | - Melisa Tasker
- Washtenaw County Community Mental Health, Ypsilanti, Michigan, USA
| | - Robert Ploutz-Snyder
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA
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Incorporation of a patient navigator into a secondary fracture prevention program identifies barriers to patient care. Aging Clin Exp Res 2020; 32:2557-2564. [PMID: 32030610 DOI: 10.1007/s40520-020-01486-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/17/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Patient navigation improves outcomes in various clinical contexts, but has not been evaluated in secondary fracture prevention. METHODS We retrospectively reviewed charts of patients, age 50 + from April to October, 2016 hospitalized with fragility fracture contacted by a patient navigator. Patients were identified using an electronic tool extracting data from electronic medical records which alerted the patient navigator to contact patients by phone post-discharge to schedule appointments to "High-Risk Osteoporosis Clinic" (HiROC) and Dual-energy X-ray Absorptiometry (DXA) scan. Primary outcome was transition from hospital to HiROC. We also compared completion of DXA, five osteoporosis-associated in-hospital laboratory tests (calcium, 25-hydroxy vitamin D, complete blood count, renal, and liver function), osteoporosis medication prescription and adherence, and other patient characteristics to historical controls (2014-2015) without patient navigation. Comparisons were made using Chi-square, Fisher's Exact, two-sample t test or Wilcoxon Rank Sum test, as appropriate. RESULTS The proportion of patients transitioning to HiROC with and without patient navigation was not different (53% vs. 48%, p = 0.483), but DXA scan completion was higher (90% vs. 67%, p = 0.006). No difference in medication initiation within 3 months post discharge (73% vs. 65%, p = 0.387) or adherence at 6 months (68% vs. 71%, p = 0.777) was found. Patients attending HiROC lived closer (11 vs. 43 miles, p < 0.001) and more likely to follow-up in surgery clinic (95% vs. 61%, p < 0.001). CONCLUSION Patient navigation did not improve transition to HiROC. Longer travel distance may be a barrier-unaffected by patient navigation. Identifying barriers may inform best practices for Fracture Liaison Service programs.
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Beverly EA, Hamel-Lambert J, Jensen LL, Meeks S, Rubin A. A qualitative process evaluation of a diabetes navigation program embedded in an endocrine specialty center in rural Appalachian Ohio. BMC Endocr Disord 2018; 18:50. [PMID: 30053846 PMCID: PMC6064115 DOI: 10.1186/s12902-018-0278-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes in the United States has reached epidemic proportions and the people of Appalachia have been disproportionately affected by this disease. Strategies that complement standard diabetes care are critically important to mitigate the risk of complications, reduce health expenditures, and improve the quality of life of patients living in rural Appalachia. The purpose of this study was to conduct a qualitative process evaluation of a patient navigation program for diabetes after its first year of implementation. METHODS The process evaluation assessed how the Diabetes Navigation Program was delivered as well as how it was experienced by the navigators, providers, health administrators, and office staff at an endocrine specialty center in rural Appalachian Ohio. We employed total population sampling to conduct in-depth, face-to-face interviews with all providers, health administrators, staff, and navigators at a Diabetes Endocrine Center. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 11 software. RESULTS Seventeen individuals (providers n = 5, health administrators n = 4, office staff members n = 3, and navigators n = 5) participated in in-depth, face-to-face interviews (age = 44.7 ± 11.6 years, 82.4% female, 94.1% white, 13.3 ± 9.6 years work experience). Fidelity of implementation: The navigation team carried out most of the activities denoted in the Work Plan, therefore the program was implemented somewhat successfully. Qualitative analysis revealed three themes: 1) The navigator addresses sources of health disparities: All participants described the role of the diabetes navigator as someone who is knowledgeable about diabetes and able to identify and address health disparities. 2) The navigators are the eyes in the community and the patients' homes: Navigators offered providers and clinic staff a rare glimpse into the personal lives of patients, which led to the identification of unrecognized barriers. 3) Difficulties with cross-system integration of services: Differences in the organizational culture and vision of the specialty center and navigation office contributed to systemic barriers. CONCLUSIONS Overall, this process evaluation highlights the importance of coordinating providers, health administrators, medical office staff, and navigators to address barriers to diabetes care. Forthcoming research is needed to document the clinical effectiveness and sustainability of the Diabetes Navigation Program in rural Appalachia.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
- The Diabetes Institute, Ohio University, Athens, OH 45701 USA
| | - Jane Hamel-Lambert
- Department of Pediatric Psychology, Nationwide Children’s Hospital, Westerville, OH 43081 USA
- Department of Clinical Pediatrics, Ohio State University, Columbus, OH 43210 USA
| | - Laura L. Jensen
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
| | - Sue Meeks
- Community Service Programs, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
| | - Anne Rubin
- Southeastern Ohio Legal Services, Athens, OH USA
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McBrien KA, Ivers N, Barnieh L, Bailey JJ, Lorenzetti DL, Nicholas D, Tonelli M, Hemmelgarn B, Lewanczuk R, Edwards A, Braun T, Manns B. Patient navigators for people with chronic disease: A systematic review. PLoS One 2018; 13:e0191980. [PMID: 29462179 PMCID: PMC5819768 DOI: 10.1371/journal.pone.0191980] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People with chronic diseases experience barriers to managing their diseases and accessing available health services. Patient navigator programs are increasingly being used to help people with chronic diseases navigate and access health services. OBJECTIVE The objective of this review was to summarize the evidence for patient navigator programs in people with a broad range of chronic diseases, compared to usual care. METHODS We searched MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, and Social Work Abstracts from inception to August 23, 2017. We also searched the reference lists of included articles. We included original reports of randomized controlled trials of patient navigator programs compared to usual care for adult and pediatric patients with any one of a defined set of chronic diseases. RESULTS From a total of 14,672 abstracts, 67 unique studies fit our inclusion criteria. Of these, 44 were in cancer, 8 in diabetes, 7 in HIV/AIDS, 4 in cardiovascular disease, 2 in chronic kidney disease, 1 in dementia and 1 in patients with more than one condition. Program characteristics varied considerably. Primary outcomes were most commonly process measures, and 45 of 67 studies reported a statistically significant improvement in the primary outcome. CONCLUSION Our findings indicate that patient navigator programs improve processes of care, although few studies assessed patient experience, clinical outcomes or costs. The inability to definitively outline successful components remains a key uncertainty in the use of patient navigator programs across chronic diseases. Given the increasing popularity of patient navigators, future studies should use a consistent definition for patient navigation and determine which elements of this intervention are most likely to lead to improved outcomes. TRIAL REGISTRATION PROSPERO #CRD42013005857.
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Affiliation(s)
- Kerry A. McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jacob J. Bailey
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane L. Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Richard Lewanczuk
- Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ted Braun
- Department of Family Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Bachman SS, Wachman M, Manning L, Cohen AM, Seifert RW, Jones DK, Fitzgerald T, Nuzum R, Riley P. Social Work's Role in Medicaid Reform: A Qualitative Study. Am J Public Health 2017; 107:S250-S255. [PMID: 29236537 DOI: 10.2105/ajph.2017.304002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To critically analyze social work's role in Medicaid reform. METHODS We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. RESULTS Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work's practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work's involvement in systems-level practice include lack of visibility, insufficient clarity on social work's role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. CONCLUSIONS Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level.
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Affiliation(s)
- Sara S Bachman
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
| | - Madeline Wachman
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
| | - Leticia Manning
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
| | - Alexander M Cohen
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
| | - Robert W Seifert
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
| | - David K Jones
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
| | - Therese Fitzgerald
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
| | - Rachel Nuzum
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
| | - Patricia Riley
- Sara S. Bachman and Madeline Wachman are with the Center for Innovation in Social Work and Health, Boston University, Boston, MA. Sara S. Bachman is also a guest editor for this supplement issue. Leticia Manning is with the US Public Health Service, Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, Rockville, MD. Alexander M. Cohen is with the Health Integration Program, Cambridge Health Alliance, Outpatient Psychiatry, Cambridge, MA. Robert W. Seifert is with the Center for Health Law and Economics, University of Massachusetts Medical School, Shrewsbury. David K. Jones is with the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston. Therese Fitzgerald is with Health Care Research, Analytics & Insights, Massachusetts Medical Society, Waltham. Rachel Nuzum is with the Federal and State Health Policy Initiative, The Commonwealth Fund, New York, NY. Patricia Riley is with the National Academy for State Health Policy, Portland, ME
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Martino SC, Grob R, Davis S, Parker AM, Finucane ML, Cerully JL, Rybowski L, Shaller D, Schlesinger M. Choosing Doctors Wisely: Can Assisted Choice Enhance Patients’ Selection of Clinicians? Med Care Res Rev 2017; 76:572-596. [DOI: 10.1177/1077558717743822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants ( N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator. Introducing patient comments enhanced engagement with the quality information but led to a decline in decision quality, particularly the consistency of choices with consumers’ stated preferences. Labeling comments helped erase the decline in decision quality, although the highest percentage of preference-congruent choices was seen in the navigator arm. Engagement with the quality information and satisfaction with choices available were likewise highest in the navigator arm. Findings held for high- and low-skilled decision makers. Thus, navigator assistance may be a promising strategy for equitably promoting higher quality choices in information-rich contexts.
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Affiliation(s)
| | - Rachel Grob
- University of Wisconsin–Madison, Madison, WI, USA
| | - Sarah Davis
- University of Wisconsin–Madison, Madison, WI, USA
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Diaz-Linhart Y, Silverstein M, Grote N, Cadena L, Feinberg E, Ruth BJ, Cabral H. Patient Navigation for Mothers with Depression who Have Children in Head Start: A Pilot Study. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:504-510. [PMID: 27195704 PMCID: PMC6013039 DOI: 10.1080/19371918.2016.1160341] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study assesses the potential of social work-facilitated patient navigation to help mothers with depression engage with mental health care. We conducted a randomized pilot trial (N = 47) in Head Start-a U.S. preschool program for low-income children. Seven lay navigators received training and supervision from professional social workers. After 6 months, more navigated participants engaged with a psychologist, therapist, or social worker (45% vs. 13%, 95% confidence interval [CI] [2, 57]); engaged with any provider, (55% vs. 26%, 95% CI [1, 56]); and reported having a "depression care provider" (80% vs. 41%, 95% CI [9, 65]). Community-based navigation appears feasible; however, more definitive testing is necessary.
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Affiliation(s)
- Yaminette Diaz-Linhart
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael Silverstein
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nancy Grote
- Graduate School of Social Work, University of Washington, Seattle, Washington, USA
| | - Lynn Cadena
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily Feinberg
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Betty J. Ruth
- Graduate School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
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Lynch S, Greeno C, Teich J, Delany P. Opportunities for social work under the Affordable Care Act: A call for action. SOCIAL WORK IN HEALTH CARE 2016; 55:651-674. [PMID: 27649338 DOI: 10.1080/00981389.2016.1221871] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Affordable Care Act (ACA) has profoundly restructured American health care. Numerous social work authors have commented on the importance of the ACA's reforms to social work practice, education, and research. This article summarizes the literature, adds relevant information, and makes recommendations for future actions. The policy, opinion, and peer-reviewed literatures were systematically reviewed. Sixty-three publications appeared between 2010 and 2015 are included. Five themes emerged, as follows: 1) the crucial provisions of the ACA, 2) the natural affinity of social work and the ACA reforms, 3) curricular adaptations needed to address changing workforce needs, 4) areas for continued social work advocacy, and 5) opportunities for high-impact social work research. This article provides a comprehensive introduction to the ACA, its reforms, and opportunities for social work to assume a high visibility leadership role in implementing the reforms, with particular emphasis on needed curricular changes and opportunities for research.
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Affiliation(s)
- Sean Lynch
- a Substance Abuse and Mental Health Services Administration , Rockville , Maryland , USA
| | - Catherine Greeno
- b School of Social Work, University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Judith Teich
- a Substance Abuse and Mental Health Services Administration , Rockville , Maryland , USA
| | - Peter Delany
- c Office of National Drug Control Policy , Washington , District of Columbia , USA
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11
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12
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Xenakis N. The Role of Social Work Leadership: Mount Sinai Care, the Accountable Care Organization, and Population Health Management. SOCIAL WORK IN HEALTH CARE 2015; 54:782-809. [PMID: 26567036 DOI: 10.1080/00981389.2015.1059399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In July 2012, The Mount Sinai Medical Center was selected by the Centers for Medicare and Medicaid to join the first cohort of Accountable Care Organizations (ACOs) in this country under its Medicare Shared Savings Program. A critical component of an ACO is care coordination of patients, which is a complex concept, intertwined with other concepts related to quality, delivery and organization of health care. This article provides an overview of the development, structure and functionality of Mount Sinai Care, the ACO of The Mount Sinai Health System, and how it was the beginning of its work in population health management. It describes the important role of social work leadership in the development and operation of its care coordination model. The model's successes and challenges and recommendations for future development of care coordination and population health management are outlined.
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Affiliation(s)
- Nancy Xenakis
- a The Mount Sinai Hospital, New York , New York , USA
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Kelly E, Ivers N, Zawi R, Barnieh L, Manns B, Lorenzetti DL, Nicholas D, Tonelli M, Hemmelgarn B, Lewanczuk R, Edwards A, Braun T, McBrien KA. Patient navigators for people with chronic disease: protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:28. [PMID: 25874724 PMCID: PMC4375835 DOI: 10.1186/s13643-015-0019-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/25/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Individuals with chronic diseases may have difficulty optimizing their health and getting the care they need due to a combination of patient, provider, and health system level barriers. Patient navigator programs, in which trained personnel assess and assist patients in overcoming barriers to care, may improve care and outcomes for patients with chronic disease by providing an alternative approach to conventional information and support resources. METHODS This systematic review will evaluate the evidence for patient navigator programs, compared to usual care, in patients with chronic disease. We will include RCTs, cluster RCTs, and quasi-randomized RCTs that study the effects of patient navigator programs on clinical outcomes, patient experience, and markers of adherence to care. Studies will be identified by searching MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, PsycINFO, Social Work Abstracts, and the references of included studies. Two authors will screen titles and abstracts independently. Full texts will be reviewed for relevance and data extraction will be done independently by two authors. Studies will be included if they assess patients of any age with one or more chronic diseases. Outcomes will be categorized into groups characterized by their proximity to mechanism of action of the intervention: patient-level outcomes, intermediate outcomes, and process outcomes. Descriptive data about the elements of the patient navigator intervention will also be collected for potential subgroup analyses. Risk of bias will be assessed using the Effective Practice and Organisation of Care Group (EPOC) risk of bias tool. Data will be analyzed using random effects meta-analysis (relative risk for dichotomous data and mean difference for continuous data), if appropriate. DISCUSSION A comprehensive review of patient navigator programs, including a summary of the elements of programs that are associated with a successful intervention, does not yet exist. This systematic review will synthesize the evidence of the effect of patient navigator interventions on clinical and patient-oriented outcomes in populations across a comprehensive set of chronic diseases. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013005857 .
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Affiliation(s)
- Elizabeth Kelly
- Department of Family Medicine, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4 N1, Canada.
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, University of Toronto, 77 Grenville Street 4th Floor, Toronto, Ontario, M5S 1B3, Canada.
| | - Rami Zawi
- Department of Family and Community Medicine, Women's College Hospital, University of Toronto, 77 Grenville Street 4th Floor, Toronto, Ontario, M5S 1B3, Canada.
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada.
| | - Braden Manns
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada. .,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - David Nicholas
- Faculty of Social Work, University of Calgary, 2800 University Way NW, Calgary, AB, T2N 1 N4, Canada.
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada.
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada. .,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Richard Lewanczuk
- Department of Medicine, University of Alberta, 362 HMRC, Edmonton, AB, T6G 2S2, Canada. .,Alberta Health Services, 10030-107 Street NW, Edmonton, AB, T5J 3E4, Canada.
| | - Alun Edwards
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada. .,Alberta Health Services, 10030-107 Street NW, Edmonton, AB, T5J 3E4, Canada.
| | - Ted Braun
- Department of Family Medicine, Alberta Health Services, Sheldon M. Chumir Health Centre, 8th Floor, 1213 - 4th Street SW, Calgary, AB, T2R 0X7, Canada.
| | - Kerry A McBrien
- Department of Family Medicine, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4 N1, Canada. .,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Ziperstein D, Ruth BJ, Clement A, Marshall JW, Wachman M, Velasquez EE. Mapping Dual-Degree Programs in Social Work and Public Health: Results From a National Survey. ADVANCES IN SOCIAL WORK 2015; 16:406-421. [PMID: 27683088 PMCID: PMC5036576 DOI: 10.18060/18372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Dramatic changes in the health system due to national health reform are raising important questions regarding the educational preparation of social workers for the new health arena. While dual-degree programs in public health and social work can be an important response to what is needed educationally, little is known about them. The National MSW/MPH Programs Study surveyed MSW/MPH program administrators to better understand the prevalence, models, structure, and challenges of these dual-degree programs. Forty-two programs were identified, and 97.6% of those contacted participated (n=41). Findings indicate that MSW/MPH programs are popular, increasing, geographically dispersed, and drawing talented students interested in trans-disciplinary public health social work practice. Challenges for these programs include the need for greater institutional support, particularly funding, and a general lack of best practices for MSW/MPH education. While findings from this study suggest graduates appear especially well-prepared for leadership and practice in the new health environment, additional research is needed to assess their particular contributions and career trajectories.
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Affiliation(s)
| | - Betty J Ruth
- MSW/MPH Program, Boston University School of Social Work
| | | | - Jamie Wyatt Marshall
- Group for Public Health Social Work based at Boston University of Social Work, in Boston, MA
| | - Madeline Wachman
- Boston University Center for Innovation in Social Work & Health, in Boston, MA
| | - Esther E Velasquez
- Harvard School of Public Health and a pre-doctoral research fellow at Brigham and Women's University in Boston, MA
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