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Harris SA, Eapen V, Kohlhoff J. Implementing a National Navigation Service for Perinatal and Infant Mental Health: Early Learnings from the ForWhen Model. Community Ment Health J 2024; 60:581-588. [PMID: 37991577 DOI: 10.1007/s10597-023-01211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
ForWhen is an Australia-based national navigation service aimed at helping parents and carers navigate the perinatal mental health service landscape and connect them with appropriate support and clinical services. The current study forms part of a mixed-methods evaluation of the ForWhen program. Semi-structured interviews were conducted with ForWhen navigators during the early design and implementation phases of the service. Results were used to characterise the ForWhen navigator activities and responsibilities, identify navigator core competencies, and examine facilitators and barriers to successful implementation of a large-scale navigation program for perinatal and infant mental health. Further research will be crucial for evidencing the utility and potential of navigation models in addressing identified issues with access to treatment for perinatal and infant mental health issues.
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Affiliation(s)
- Sophia A Harris
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Academic Unit of Infant, Child & Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Sydney, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
- , Karitane, Sydney, Australia.
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Cochran G, Smid MC, Krans EE, Yu Z, Carlston K, White A, Abdulla W, Baylis J, Charron E, Okifugi A, Gordon AJ, Lundahl B, Silipigni J, Seliski N, Haaland B, Tarter R. Patient navigation for pregnant individuals with opioid use disorder: Results of a randomized multi-site pilot trial. Addiction 2024; 119:544-556. [PMID: 37859587 DOI: 10.1111/add.16364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND AND AIMS Patient navigation (PN) may benefit pregnant individuals with opioid use disorder (OUD) by improving treatment adherence. We examined participant enrollment, session delivery and assessment feasibility for a PN intervention among pregnant participants and compared PN preliminary effectiveness for OUD treatment engagement with participants in usual care (UC). DESIGN This study was a pilot single-blinded multi-site randomized trial. SETTING Two academic medical centers in Pennsylvania (n = 57) and Utah (n = 45), United States participated. PARTICIPANTS One hundred and two pregnant adult participants unestablished (fewer than 6 weeks) on medication for OUD (MOUD) were randomized to PN (n = 53) or UC (n = 49). INTERVENTION PN was composed of 10 prenatal sessions (delivered after baseline but before the prenatal assessments) and four postnatal sessions (delivered before the 2- and 6-month postpartum assessments) focused upon OUD treatment and physical/mental health needs. UC involved brief case management. MEASUREMENTS Feasibility assessments included consent, session delivery and assessment rates. Mixed-effect models for intent-to-treat (ITT) and per protocol (PP, received six or more sessions) populations were estimated to compare outcomes of MOUD use, secondary outcomes of substance use disorder (SUD) treatment attendance and non-prescribed opioid use, and exploratory outcome of overdose at baseline, predelivery and 2 and 6 months postpartum. FINDINGS We consented 87% (106 of 122) of the proposed target, delivered ~60% of sessions delivered and completed ≥ 75% assessments. PN ITT and PP had better MOUD adherence, SUD treatment attendance, non-prescribed opioid use and overdose outcomes than UC. Notable changes included good evidence for greater percentage change in days for PN PP MOUD use from baseline to 2 months postpartum [PN = 28.0 versus UC = -10.9, 95% confidence interval (CI) = 9.7, 62.1] and some evidence for baseline to 6 months postpartum (PN = 45.4 versus UC = 23.4, 95% CI = -0.7, 48.2). PN PP percentage change in days for SUD treatment attendance also showed good evidence for improvements from baseline to prenatal assessment (PN = 7.4 versus UC = -21.3, 95% CI = 3.3, 53.5). PN compared to UC participants reported fewer overdoses at 2 months (PN = 11.9%/UC = 16.1%) and at 6 months postpartum (PN = 3.8%/UC = 6.2%). CONCLUSIONS Patient navigation appears to be associated with improvements in opioid use disorder treatment engagement and overdoses during pregnancy. This pilot trial shows the feasibility of the intervention and a future large-scale trial.
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Affiliation(s)
- Gerald Cochran
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC, Pittsburgh, PA, USA
| | - Ziji Yu
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristi Carlston
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ashley White
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Walitta Abdulla
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC, Pittsburgh, PA, USA
| | - Jacob Baylis
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elizabeth Charron
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Akiko Okifugi
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Adam J Gordon
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Brad Lundahl
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - John Silipigni
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Natasha Seliski
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ralph Tarter
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
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Kamimura-Nishimura K, Bush H, Amaya de Lopez P, Crosby L, Jacquez F, Modi AC, Froehlich TE. Understanding Barriers and Facilitators of Attention-Deficit/Hyperactivity Disorder Treatment Initiation and Adherence in Black and Latinx Children. Acad Pediatr 2023; 23:1175-1186. [PMID: 36997150 PMCID: PMC10524141 DOI: 10.1016/j.acap.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Despite evidence that consistent treatment is important for Attention-Deficit/Hyperactivity Disorder (ADHD) management, ADHD treatment initiation and adherence remains suboptimal in minoritized children. The goal of this study was to explore barriers and facilitators to ADHD treatment initiation/adherence for minoritized children to further inform development of our family navigation intervention. METHODS Using a virtual platform, we completed 7 focus group sessions (total n.ß=.ß26) and 6 individual interviews with representatives from 4 stakeholder groups: experienced caregivers of children with ADHD, caregivers of children newly diagnosed with ADHD, family navigators, and clinicians who care for children with ADHD. All caregivers identified as Black and/or Latinx. Separate sessions were conducted for each stakeholder group and caregivers had the option to attend an English or Spanish session. Using a thematic analysis strategy, barriers and facilitators to ADHD treatment initiation and/or adherence were coded in focus group/interview data and themes were identified across groups. RESULTS The primary barriers to ADHD treatment initiation and/or adherence identified for minoritized children were lack of support from school/healthcare/family members, cultural barriers, limited resources, limited access, and treatmentconcerns, with variability in endorsement across participants. Reported facilitators included caretakers having experience with ADHD, strong support, access to resources, andwitnessing their child...s functional improvement with treatment. CONCLUSIONS Caregiver experience with and knowledge about ADHD, support, and access to resources facilitate ADHD treatment in minoritized children. The results from this study have the potential to improve ADHD treatment initiation/adherence and outcomes for minoritized children through the development of culturally tailored, multipronged interventions.
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Affiliation(s)
- Kelly Kamimura-Nishimura
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Hannah Bush
- Department of Pediatrics (H Bush), Cincinnati Children...s Hospital Medical Center, Ohio.
| | - Paola Amaya de Lopez
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Lori Crosby
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Farrah Jacquez
- Department of Psychology (F Jacquez), University of Cincinnati, Ohio.
| | - Avani C Modi
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Tanya E Froehlich
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Franklin EF, Dean MS, Johnston DM, Nevidjon BM, Burke SL, Simms Booth LM. Solidifying roles, responsibilities, and the process of navigation across the continuum of cancer care: The Professional Oncology Navigation Task Force. Cancer 2022; 128 Suppl 13:2669-2672. [PMID: 35699615 DOI: 10.1002/cncr.34095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022]
Abstract
Since its founding in 1990, the profession of oncology navigation has grown and evolved. Although core concepts serve as a unifying thread throughout the profession, there has not been formal agreement on standardization of definitions, scopes, and roles for the various types of navigators. This has created challenges for sustainability, including reimbursement for navigation services. Emerging from the Biden Cancer Initiative's patient navigation working group, the Professional Oncology Navigation Task Force was created to serve as the voice of professional oncology organizations with an ultimate goal of solidifying definitions, scopes, and roles of navigators across the care continuum. Task group members are committed to cross-disciplinary partnership (including nursing, social work, and nonclinically licensed navigation). As the Task Force worked to define, refine, and disseminate professional standards (with input from the navigation community), the work done by the National Navigation Roundtable was vital to our evolving understanding of the profession. This article outlines the importance of that partnership and highlights the relevant findings of each article in this supplement of Cancer to the standardization work. LAY SUMMARY: Within the profession of oncology navigation, definitions, scopes, and roles of navigators have not been solidified. Standardization of the profession is critical to allow for continued growth and evolution as well as policy direction. This article introduces the work of the Professional Oncology Navigation Task Force, which created the Oncology Navigation Standards of Professional Practice with input from professional leaders and community stakeholders. The article also links the work of the National Navigation Roundtable and the critical need to coordinate and amplify efforts across groups.
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Affiliation(s)
| | - Monica S Dean
- Academy of Oncology Nurse and Patient Navigators, Cranbury, New Jersey
| | | | | | - Susie L Burke
- Association of Pediatric Hematology/Oncology Nurses, Chicago, Illinois
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Gardiner E, Wong V, Lin G, Miller AR. Terminology and descriptions of navigation and related practices for children with neurodisability and their families: a scoping review. BMC Health Serv Res 2022; 22:214. [PMID: 35177039 PMCID: PMC8851781 DOI: 10.1186/s12913-022-07617-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with neurodisability (ND) represent a significant population with a demonstrated need for coordinated support. Patient navigation has a primary focus on: facilitating access to and connection amongst fragmented systems; as well as the provision of educational and emotional support. Given the distinct needs of children with ND and their families, programs built upon such core concepts could be of great benefit. The diversity of terminology encompassing navigation-related concepts and activities (e.g., care coordination, case management, family support), however, presents challenges to both practice and research. This scoping review examined the terminology and descriptions provided within published articles on navigation-type models for children with ND and their families. METHODS The scoping review was conducted according to the Joanna Briggs Institute methodology. A preliminary search was completed on PubMed (NCBI), MEDLINE (Ovid) and CINAHL (EBSCO) to identify initial search terms, upon which a full search strategy was developed and executed in MEDLINE (Ovid) and CINAHL (EBSCO). After screening records according to our inclusion and exclusion criteria, a full-text review of relevant articles was conducted and data extracted using a researcher-developed tool. Under close supervision by the research team, study selection was primarily performed by one author. RESULTS Of the 2597 papers identified, 33 were included in the final review. From the included papers, a total of 49 terms were extracted, 20 of which were unique. Across the diversity of terminology observed, articles provided detailed and rich descriptions characterized by four central domains, namely: (i) what navigation-related resources, supports and services aim to facilitate and (ii) provide; (iii) descriptions of their intended outcomes; as well as (iv) guiding principles. CONCLUSIONS This scoping review addresses a gap in our knowledge related to the specification of patient navigation and related supports as applied to the specific context of children with ND and their families. Given the particular needs of this population, we propose an empirically-informed integrative model that synthesizes the findings from this scoping review. We suggest that this framework can be used as a guide to the mindful characterization of how supports aiming to connect children and families to needed service are termed and described within future research and in practice.
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Affiliation(s)
- Emily Gardiner
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada. .,Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Vivian Wong
- Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.,Sunny Hill Health Centre at BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Grace Lin
- School of Medicine, Queen's University, 15 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Anton R Miller
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.,Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
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Kokorelias KM, Shiers-Hanley JE, Rios J, Knoepfli A, Hitzig SL. Factors Influencing the Implementation of Patient Navigation Programs for Adults with Complex Needs: A Scoping Review of the Literature. Health Serv Insights 2021; 14:11786329211033267. [PMID: 34349519 PMCID: PMC8287353 DOI: 10.1177/11786329211033267] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Patient navigation is a model of care that aims to improve access to care by reducing the complexity of navigating health, education, and social services across the continuum of care and care settings. Little is known about the processes that facilitate or impede the implementation of patient navigation programs (PNPs). We conducted a scoping review to identify and summarize the current state of knowledge regarding the implementation and outcomes of existing implemented PNPs. We employed a 6-stage scoping review framework to identify and review eligible articles. Sixty-articles met the inclusion criteria (58 peer-reviewed and 2 grey literature). The Consolidated Framework for Implementation Research served as the theoretical framework during analysis to help extract factors relevant to implementation of navigator programs. Results of the scoping review are reported thematically. Influences on implementation were identified: (a) planning to ensure alignment with organizational need (b) funding (c) multidisciplinary engagement (d) establishing workflow (e) mechanisms for communication (f) stakeholders to encourage buy-in (g) appropriate caseload (h) in kind resources. PNPs improve the experiences of patients and families. The findings of this scoping review provides implementation considerations of PNPs across global care settings. Strategies for overcoming pragmatic and logistical issues must be developed for optimal implementation.
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Affiliation(s)
- Kristina M Kokorelias
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Jessica E Shiers-Hanley
- Hazel McCallion Academic Learning
Centre, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
| | - Jorge Rios
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Amanda Knoepfli
- Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
- SPRINT Senior Care, Toronto, ON,
Canada
| | - Sander L Hitzig
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
- Rehabilitation Sciences Institute,
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Livergant RJ, Ludlow NC, McBrien KA. Needs assessment for the creation of a community of practice in a community health navigator cohort. BMC Health Serv Res 2021; 21:657. [PMID: 34225704 PMCID: PMC8256652 DOI: 10.1186/s12913-021-06507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Community Health Navigators (CHNs) are members of a patient's care team that aim to reduce barriers in accessing healthcare. CHNs have been described in various healthcare settings, including chronic disease management. The ENhancing COMmunity health through Patient navigation, Advocacy, and Social Support (ENCOMPASS) program of research employs CHNs, who are trained to improve access to care and community resources for patients with multiple chronic diseases. With complex and demanding roles, it is essential that CHNs communicate with each other to maintain knowledge exchange and best practices. A Community of Practice (CoP) is a model of situated learning that promotes communication, dedication, and collaboration that can facilitate this communication. The objective of this study was to engage with CHNs to determine how a CoP could be implemented to promote consistency in practices and knowledge for CHNs across primary care sites. METHODS A needs assessment for a CHN CoP was conducted using sequential steps of inquiry. A preliminary focused literature review (FLR) was done to examine the ways in which other healthcare CoPs have been implemented. Results from the FLR guided the creation of an exploratory survey and group interview with key informants to understand best approaches for CoP creation. Political, economic, social, and technological (PEST) and strengths, weaknesses, opportunities, and threats (SWOT) analyses synthesized results in a comprehensive manner for strategic recommendations. RESULTS The FLR identified different approaches and components of healthcare CoPs and guided analyses of mitigatable risk factors and leverageable assets for the intervention. The survey and group interview revealed an informal and effective CoP amongst current CHNs, with preferred methods including coffee meetings, group trainings, and seminars. A well-maintained web platform with features such as an encrypted discussion forum, community resource listing, calendar of events, and semi-annual CHN conferences were suggested methods for creating an inter-regional, formal CoP. CONCLUSION The study findings recognise the presence of an informal CoP within the studied CHN cohort. Implementation of a formal CoP should complement current CoP approaches and aid in facilitating expansion to other primary care centres utilizing digital communication methods, such as a comprehensive web platform and online forum.
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Affiliation(s)
- Rachel J Livergant
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Natalie C Ludlow
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Kerry A McBrien
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Kowalkowski M, Eaton T, McWilliams A, Tapp H, Rios A, Murphy S, Burns R, Gutnik B, O'Hare K, McCurdy L, Dulin M, Blanchette C, Chou SH, Halpern S, Angus DC, Taylor SP. Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS). BMC Health Serv Res 2021; 21:544. [PMID: 34078374 PMCID: PMC8170654 DOI: 10.1186/s12913-021-06521-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sepsis survivors experience high morbidity and mortality, and healthcare systems lack effective strategies to address patient needs after hospital discharge. The Sepsis Transition and Recovery (STAR) program is a navigator-led, telehealth-based multicomponent strategy to provide proactive care coordination and monitoring of high-risk patients using evidence-driven, post-sepsis care tasks. The purpose of this study is to evaluate the effectiveness of STAR to improve outcomes for sepsis patients and to examine contextual factors that influence STAR implementation. METHODS This study uses a hybrid type I effectiveness-implementation design to concurrently test clinical effectiveness and gather implementation data. The effectiveness evaluation is a two-arm, pragmatic, stepped-wedge cluster randomized controlled trial at eight hospitals in North Carolina comparing clinical outcomes between sepsis survivors who receive Usual Care versus care delivered through STAR. Each hospital begins in a Usual Care control phase and transitions to STAR in a randomly assigned sequence (one every 4 months). During months that a hospital is allocated to Usual Care, all eligible patients will receive usual care. Once a hospital transitions to STAR, all eligible patients will receive STAR during their hospitalization and extending through 90 days from discharge. STAR includes centrally located nurse navigators using telephonic counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted with suspected sepsis, defined by clinical criteria for infection and organ failure, are included. Planned enrollment is 4032 patients during a 36-month period. The primary effectiveness outcome is the composite of all-cause hospital readmission or mortality within 90 days of discharge. A mixed-methods implementation evaluation will be conducted before, during, and after STAR implementation. DISCUSSION This pragmatic evaluation will test the effectiveness of STAR to reduce combined hospital readmissions and mortality, while identifying key implementation factors. Results will provide practical information to advance understanding of how to integrate post-sepsis management across care settings and facilitate implementation, dissemination, and sustained utilization of best-practice post-sepsis management strategies in other heterogeneous healthcare delivery systems. TRIAL REGISTRATION NCT04495946 . Submitted July 7, 2020; Posted August 3, 2020.
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Affiliation(s)
- Marc Kowalkowski
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA.
| | - Tara Eaton
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
| | - Andrew McWilliams
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA.,Department of Internal Medicine, Atrium Health, Charlotte, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, USA
| | - Aleta Rios
- Ambulatory Care Management, Atrium Health, Charlotte, USA
| | | | - Ryan Burns
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
| | - Bella Gutnik
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
| | | | - Lewis McCurdy
- Division of Infectious Disease, Department of Internal Medicine, Atrium Health, Charlotte, USA
| | - Michael Dulin
- Academy for Population Health Innovation, University of North Carolina Charlotte & Mecklenburg County Public Health Department, Charlotte, USA.,Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, USA
| | - Christopher Blanchette
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, USA.,Health Economics and Outcomes Research Strategy, Novo Nordisk, Plainsboro Township, USA
| | - Shih-Hsiung Chou
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
| | - Scott Halpern
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
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10
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Feinberg E, Kuhn J, Eilenberg JS, Levinson J, Patts G, Cabral H, Broder-Fingert S. Improving Family Navigation for Children With Autism: A Comparison of Two Pilot Randomized Controlled Trials. Acad Pediatr 2021; 21:265-271. [PMID: 32302757 PMCID: PMC7554108 DOI: 10.1016/j.acap.2020.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Family navigation (FN), a care management strategy, helps families overcome systems and person-level barriers to care. We previously demonstrated FN's feasibility, acceptability, and potential efficacy for increasing access and reducing time to autism-related diagnostic services among low-income, minority children. In this paper, we describe modifications to FN in response to concerns raised in our first pilot randomized controlled trial (RCT), and then assess these modifications in a second pilot RCT. METHODS An advisory group recommended modifications to recruitment procedures and study conditions. Forty parent-child dyad participants with autism-related concerns were randomized to receive modified usual care (UC) or modified FN. We compared whether the first and second pilot RCTs differed in: participant enrollment, satisfaction with clinical care, and timely completion of the diagnostic assessment. RESULTS Recruitment improved under the modified protocol with significantly fewer potentially eligible families refusing (19.5% vs 4.8%, P < .05) or being excluded from study enrollment (43.6% vs 0%, P < .01). Comparing the first and second pilot RCTs, regardless of study arm, families in the second pilot were more likely to complete diagnostic assessment (UC: hazard ratio [HR] 3.41, 95% confidence intervals [CI 1.20, 9.68]; FN: HR 2.64, 95% CI [1.31, 5.30]) and report greater satisfaction with clinical care. In the second pilot, compared to UC, FN continued increase the likelihood of completing the diagnostic assessment (HR: 2.57; 95% CI [1.22, 5.40]). CONCLUSIONS Easy-to-implement system-level enhancements improved study recruitment, satisfaction with care, and completion of a diagnostic assessment. With enhancement, FN continued to confer benefits to families.
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Affiliation(s)
- Emily Feinberg
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine (E Feinberg, and S Broder-Fingert), Boston, Mass; Boston University School of Public Health (E Feinberg, JS Eilenberg, J Levinson, G Patts, and H Cabral), Boston, Mass.
| | - Jocelyn Kuhn
- Department of Pediatrics, Boston Medical Center, 801 Albany St, Boston, MA 02119
| | | | - Julia Levinson
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Gregory Patts
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Howard Cabral
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Sarabeth Broder-Fingert
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany St, Boston, MA 02119
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11
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Martinez A, Allen A. A review of nonpharmacological adjunctive treatment for postpartum women with opioid use disorder. Addict Behav 2020; 105:106323. [PMID: 32036191 DOI: 10.1016/j.addbeh.2020.106323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/16/2019] [Accepted: 01/16/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Over the past decade, opioid use disorder (OUD) among pregnant women has increased by over 400%. Although medication assisted treatment (MAT) provides necessary care for women with OUD, effective adjunctive nonpharmacological treatments have not been systematically identified. This is especially concerning for the postpartum period, which includes several unique risk factors (e.g., sleep deprivation, mood disturbances) for MAT non-adherence and relapse. This review summarizes the existing knowledge regarding nonpharmacological treatments for OUD during the postpartum period, as well as provides recommendations for the future. METHODS PubMed and PsycINFO were searched in July 2018 using combinations of 28 keywords. Eligibility criteria included: (1) coverage of postpartum period, (2) use of nonpharmacological treatment for OUD, (3) conducted in clinical samples, and (4) written in English. RESULTS A total of 4 out of 38 identified articles met eligibility criteria. Two of the studies offered weekly on-site group counseling, with one also offering monthly social worker meetings. The third study offered four sessions with a patient navigator during the postpartum period. The last offered an employment intervention. All four reported favorable effects on OUD at end of follow-up (range: 30 days postpartum to 1 year postpartum). However, the details of the interventions, methodologies, and abstinence rates were sparse. DISCUSSION Few published studies examine nonpharmacological OUD treatments specific to the postpartum period. Identification of adjunctive nonpharmacological treatments designed to the unique needs of postpartum women is of critical public health importance, and further research is needed.
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12
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Cochran G, Smid MC, Krans EE, Bryan MA, Gordon AJ, Lundahl B, Silipigni J, Haaland B, Tarter R. A pilot multisite study of patient navigation for pregnant women with opioid use disorder. Contemp Clin Trials 2019; 87:105888. [PMID: 31731006 PMCID: PMC7201898 DOI: 10.1016/j.cct.2019.105888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022]
Abstract
The opioid crisis continues to affect pregnant and postpartum women the United States, with the number of pregnant women diagnosed with opioid use disorder (OUD) quadrupling over the last decade. The associated increase in morbidity and mortality among mother and baby warrants prompt, targeted intervention efforts that improve engagement, linkage of care, and treatment retention. Patient navigation (PN) is a chronic care intervention that can directly address this need by helping women identify medical, behavioral, and psychosocial care goals. Moreover, PN can assist women in preparing for, engaging in, and maintaining patient participation in necessary services. Specifically, PN includes strengths-based case management, 1-1 clinical support, motivational interviewing, and addiction-relapse prevention programming. The objective of this article is to present the study protocol of a pilot multisite randomized clinical trial, entitled: Optimizing Pregnancy and Treatment Interventions for Moms 2.0 (OPTI-Mom 2.0; NCT03833245). In this study, we build upon a proof-of-concept study, employing evidence-informed frameworks for protocol and intervention expansion in order to construct a PN intervention tailored for pregnant women with OUD in central Utah and southwestern Pennsylvania. Our protocol provides an initial framework of a potentially impactful intervention and may guide development of future programs. Importantly, this study further establishes the evidence-base-with potential to ameliorate serious adverse opioid-related outcomes and improve health for women and their children.
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Affiliation(s)
- Gerald Cochran
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States.
| | - Marcela C Smid
- Department of Maternal Fetal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, United States
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Research Institute, 300 Halket Street, Pittsburgh, PA, United States
| | - M Aryana Bryan
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; University of Utah College of Social Work, 395 S 1500 E #111, Salt Lake City, UT, United States
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Brad Lundahl
- University of Utah College of Social Work, 395 S 1500 E #111, Salt Lake City, UT, United States
| | - John Silipigni
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Research Institute, 300 Halket Street, Pittsburgh, PA, United States
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah School of Medicine 30 N 1900 E, Salt Lake City, UT, United States
| | - Ralph Tarter
- University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, United States
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13
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Cochran GT, Hruschak V, Abdullah W, Krans E, Douaihy AB, Bobby S, Fusco R, Tarter R. Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom): A Pilot Study. J Addict Med 2019; 12:72-79. [PMID: 29140822 PMCID: PMC5786468 DOI: 10.1097/adm.0000000000000370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The public health burden of opioid use disorder (OUD) among pregnant women has significantly increased in recent years. The Optimizing Pregnancy Treatment Interventions for Moms study was a pilot project that examined the feasibility of a patient navigation (PN) intervention model to reduce substance use and improve mental health, quality of life, and to increase engagement with treatment services among pregnant women with OUD. METHODS A 1-group repeated-measures pilot study was conducted with treatment-seeking pregnant women with opioid dependence initiating buprenorphine maintenance treatment. Participants received the PN intervention delivered as 10 sessions before delivery and 4 sessions postpartum. Participants completed assessments at baseline and after the prenatal and postnatal portions of the intervention. Demographics were assessed using descriptive statistics, and general estimating equation analyses were employed to examine changes in health and service engagement across time. RESULTS in all, 21 women were enrolled and completed the PN intervention and follow-up assessments. Participants reported improvements in abstinence from illicit opioids (B = 0.15, 95% confidence interval [CI] 0.1-0.2), drug use (odds ratio [OR] 5.25, 95% CI 2.1-13.0), and depression (OR 7.70, 95% CI 2.4-25.1). Results also showed nonsignificant trends suggesting enhancements in general health (B = 0.17, 95% CI 0.0-0.3, P = 0.06) and increases in substance use treatment attendance (B = 2.15, 95% CI -0.2 to 4.5, P = 0.07). Most study participants achieved adequate or better prenatal care. CONCLUSIONS These findings provide support that PN is a feasible adjunctive intervention that shows promise for health improvements and service engagement among treatment-seeking pregnant women with opioid dependence initiating buprenorphine.
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Affiliation(s)
- Gerald T Cochran
- University of Pittsburgh, School of Social Work, Pittsburgh, PA (GC, VH, RF); University of Pittsburgh, School of Medicine, Pittsburgh, PA (GC); UPMC, Magee-Womens Hospital, Pittsburgh, PA (WA); University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA (EK); University of Pittsburgh, School of Medicine, Pittsburgh, PA (ABD); Pregnancy Recovery Center, UPMC, Magee-Womens Hospital, Pittsburgh, PA (SB); University of Pittsburgh, School of Pharmacy, Pittsburgh, PA (RT)
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14
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Godoy L, Hodgkinson S, Robertson HA, Sham E, Druskin L, Wambach CG, Beers LS, Long M. Increasing Mental Health Engagement From Primary Care: The Potential Role of Family Navigation. Pediatrics 2019; 143:peds.2018-2418. [PMID: 30877145 DOI: 10.1542/peds.2018-2418] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/24/2022] Open
Abstract
Early engagement in mental health intervention is critical, yet the vast majority of children who are experiencing mental health concerns are not receiving needed services. Pediatric primary care clinics have been recognized as an ideal setting in which to identify and address mental health problems early, although engagement in mental health services within primary care and in community-based settings remains low. Navigators, or individuals with experience in navigating the mental health system, have been highlighted as promising partners in efforts to improve engagement in mental health services. Navigation has a growing body of research support among adults and in targeting medical concerns, but there has been limited research on integrating family navigators into pediatric primary care settings to address mental health concerns. Despite this gap in the evidence base, we believe there is significant promise for the use of this model in addressing children's mental health needs. In this report, we discuss factors contributing to high levels of unmet mental health needs and low levels of engagement in mental health services, the role that navigators can play in increasing engagement in mental health care, and implications and recommendations related to integrating mental health-focused family navigators into pediatric primary care settings.
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Affiliation(s)
- Leandra Godoy
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia; .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Stacy Hodgkinson
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | | | - Elyssa Sham
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Lindsay Druskin
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | | | - Lee Savio Beers
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Melissa Long
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
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15
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Abstract
Purpose Given the pace of industry change and the rapid diffusion of high reliability organization (HRO) approaches, lags and divergences have arisen between research and practice in healthcare. The purpose of this paper is to explore several of these theory-practice gaps and propose implications for research and practice. Design/methodology/approach Classic and cutting-edge HRO literature is applied to analyze two industry trends: delivery system integration, and the confluence of patient-as-consumer and patient-centered care. Findings Highly reliable integrated delivery systems will likely function very differently from classic HRO organizations. Both practitioners and researchers should address conditions such as how a system is bounded, how reliable the system should be and how interdependencies are handled. Additionally, systems should evaluate the added uncertainty and variability introduced by enhanced agency on the part of patients/families in decision making and in processes of care. Research limitations/implications Dramatic changes in the sociotechnical environment are influencing the coupling and interactivity of system elements in healthcare. Researchers must address the maintenance of reliability across organizations and the migration of decision-making power toward patients and families. Practical implications As healthcare systems integrate, managers attempting to apply HRO principles must recognize how these systems present new and different reliability-related challenges and opportunities. Originality/value This paper provides a starting point for the advancement of research and practice in high-reliability healthcare by providing an in-depth exploration of the implications of two major industry trends.
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Affiliation(s)
- Peter F Martelli
- Sawyer Business School, Suffolk University , Boston, Massachusetts, USA
| | - Peter E Rivard
- Sawyer Business School, Suffolk University , Boston, Massachusetts, USA
| | - Karlene H Roberts
- Haas School of Business, University of California Berkeley , Berkeley, California, USA
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16
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Basu M, Petgrave-Nelson L, Smith KD, Perryman JP, Clark K, Pastan SO, Pearson TC, Larsen CP, Paul S, Patzer RE. Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population: A Randomized, Controlled Trial. Clin J Am Soc Nephrol 2018; 13:620-627. [PMID: 29581107 PMCID: PMC5968906 DOI: 10.2215/cjn.08600817] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients. RESULTS At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (<500 days from referral) to late (≥500 days) follow-up. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03). CONCLUSIONS A transplant center-based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.
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Affiliation(s)
- Mohua Basu
- Division of Transplantation, Department of Surgery and
| | | | - Kayla D. Smith
- Division of Transplantation, Department of Surgery and
- Emory Transplant Center, Atlanta, Georgia; and
| | | | - Kevin Clark
- Emory Transplant Center, Atlanta, Georgia; and
| | - Stephen O. Pastan
- Renal Division, Emory University School of Medicine, Atlanta, Georgia
- Emory Transplant Center, Atlanta, Georgia; and
| | - Thomas C. Pearson
- Division of Transplantation, Department of Surgery and
- Emory Transplant Center, Atlanta, Georgia; and
| | - Christian P. Larsen
- Division of Transplantation, Department of Surgery and
- Emory Transplant Center, Atlanta, Georgia; and
| | - Sudeshna Paul
- Office of Nursing Research, Nell Hodgson Woodruff School of Nursing and
| | - Rachel E. Patzer
- Division of Transplantation, Department of Surgery and
- Emory Transplant Center, Atlanta, Georgia; and
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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17
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Peart A, Lewis V, Brown T, Russell G. Patient navigators facilitating access to primary care: a scoping review. BMJ Open 2018; 8:e019252. [PMID: 29550777 PMCID: PMC5875656 DOI: 10.1136/bmjopen-2017-019252] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/06/2018] [Accepted: 02/12/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Patient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred. SETTING AND PARTICIPANTS We used the Arksey and O'Malley scoping review method. Searches were conducted in MEDLINE, Embase, ProQuest Medical, other key databases and grey literature for studies reported in English from January 2000 to April 2016. We defined a patient navigator as a person or process creating a connection or link between a person needing primary care and a primary care provider. Our target population was people without a regular source of, affiliation or connection with primary care. Studies were included if they reported on participants who were connected to primary care by patient navigation and attended or made an appointment with a primary care provider. Data analysis involved descriptive numerical summaries and content analysis. RESULTS Twenty studies were included in the final scoping review. Most studies referred to 'patient navigator' or 'navigation' as the mechanism of connection to primary care. As such, we grouped the components according to Freeman's nine-principle framework of patient navigation. Seventeen studies included elements of patient-centred care: informed and involved patient, receptive and responsive health professionals and a coordinated, supportive healthcare environment. CONCLUSIONS Patient navigators may assist to connect people requiring primary care to appropriate providers and extend the concept of patient-centred care across different healthcare settings. Navigation requires further study to determine impact and cost-effectiveness and explore the experience of patients and their families.
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Affiliation(s)
- Annette Peart
- Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Australia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia
| | - Ted Brown
- Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Australia
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18
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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: 156] [Impact Index Per Article: 26.0] [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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19
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Luke A, Doucet S, Azar R. Paediatric patient navigation models of care in Canada: An environmental scan. Paediatr Child Health 2018; 23:e46-e55. [PMID: 29769815 DOI: 10.1093/pch/pxx176] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives (1) To provide other organizations with useful information when implementing paediatric navigation programs and (2) to inform the implementation of a navigation care centre in New Brunswick for children with complex health conditions. Methods This environmental scan consisted of a literature review of published and grey literature for paediatric patient navigation programs across Canada. Additional programs were found following discussions with program coordinators and navigators. Interviews were conducted with key staff from each program and included questions related to patient condition; target population and location; method delivery; navigator background; and navigator roles. Data analysis included analysis of interviews and identification of common themes across the different programs. Results We interviewed staff from 19 paediatric navigation programs across Canada. Programs varied across a number of different themes, including: condition and disease type, program location (e.g., hospital or clinic), navigator background (e.g., registered nurse or peer/lay navigator) and method of delivery (e.g., phone or face-to-face). Overall, navigator roles are similar across all programs, including advocacy, education, support and assistance in accessing resources from both within and outside the health care system. Discussion This scan offers a road map of Canadian paediatric navigation programs. Knowledge learned from this scan will inform stakeholders who are either involved in the delivery of paediatric patient navigation programs or planning to implement such a program. Specifically, our scan informed the development of a navigation centre for children with complex health conditions in New Brunswick.
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Affiliation(s)
- Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick
| | - Rima Azar
- Department of Psychology, Mount Allison University, Sackville, New Brunswick
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20
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Ali-Faisal SF, Colella TJF, Medina-Jaudes N, Benz Scott L. The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2017; 100:436-448. [PMID: 27771161 DOI: 10.1016/j.pec.2016.10.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/09/2016] [Accepted: 10/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the effects of patient navigation (PN) on healthcare utilization outcomes using meta-analysis and the quality of evidence. METHODS Medical and social science databases were searched for randomized controlled trials published in English between 1989 and May 2015. The review process was guided by PRISMA. Included studies were assessed for quality using the Downs and Black tool. Data were extracted to assess the effect of navigation on: health screening rates, diagnostic resolution, cancer care follow-up treatment adherence, and attendance of care events. Random-effects models were used to compute risk ratios and I2 statistics determined the impact of heterogeneity. RESULTS Of 3985 articles screened, 25 articles met inclusion criteria. Compared to usual care, patients who received PN were significantly more likely to access health screening (OR 2.48, 95% CI, 1.93-3.18, P<0.00001) and attend a recommended care event (OR 2.55, 95% CI, 1.27-5.10, P<0.01). PN was favoured to increase adherence to cancer care follow-up treatment and obtain diagnoses. Most studies involved trained lay navigators (n=12) compared to health professionals (n=9). CONCLUSION PN is effective to increase screening rates and complete care events. PRACTICE IMPLICATIONS PN is an effective intervention for use in healthcare.
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Affiliation(s)
- Sobia F Ali-Faisal
- Program in Public Health, Stony Brook Medicine, Stony Brook University, Stony Brook, USA.
| | - Tracey J F Colella
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; University Health Network/Toronto Rehabilitation Cardiovascular Prevention & Rehabilitation Program, Toronto, Canada.
| | - Naomi Medina-Jaudes
- Program in Public Health, Stony Brook Medicine, Stony Brook University, Stony Brook, USA.
| | - Lisa Benz Scott
- Program in Public Health, Stony Brook Medicine, Stony Brook University, Stony Brook, USA; The School of Health Technology & Management, Stony Brook University, Stony Brook, USA.
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21
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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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22
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Patterns of task and network actions performed by navigators to facilitate cancer care. Health Care Manage Rev 2014; 39:90-101. [PMID: 23478753 DOI: 10.1097/hmr.0b013e31828da41e] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient navigation is a widely implemented intervention to facilitate access to care and reduce disparities in cancer care, but the activities of navigators are not well characterized. PURPOSE The aim of this study is to describe what patient navigators actually do and explore patterns of activity that clarify the roles they perform in facilitating cancer care. METHODOLOGY/APPROACH We conducted field observations of nine patient navigation programs operating in diverse health settings of the national patient navigation research program, including 34 patient navigators, each observed an average of four times. Trained observers used a structured observation protocol to code as they recorded navigator actions and write qualitative field notes capturing all activities in 15-minute intervals during observations ranging from 2 to 7 hours; yielding a total of 133 observations. Rates of coded activity were analyzed using numerical cluster analysis of identified patterns, informed by qualitative analysis of field notes. FINDINGS Six distinct patterns of navigator activity were identified, which differed most relative to how much time navigators spent directly interacting with patients and how much time they spent dealing with medical records and documentation tasks. Navigator actions reveal a complex set of roles in which navigators both provide the direct help to patients denoted by their title and also carry out a variety of actions that function to keep the health system operating smoothly. PRACTICE IMPLICATIONS Working to navigate patients through complex health services entails working to repair the persistent challenges of health services that can render them inhospitable to patients. The organizations that deploy navigators might learn from navigators' efforts and explore alternative approaches, structures, or systems of care in addressing both the barriers patients face and the complex solutions navigators create in helping patients.
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Kelly E, Fulginiti A, Pahwa R, Tallen L, Duan L, Brekke JS. A pilot test of a peer navigator intervention for improving the health of individuals with serious mental illness. Community Ment Health J 2014; 50:435-46. [PMID: 23744292 DOI: 10.1007/s10597-013-9616-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
Individuals with serious mental illness (SMI) are at considerably higher risk for morbidity and mortality than those in the general population. The current pilot trial is a preliminary examination of a peer health navigation intervention for improving health and healthcare utilization called the Bridge. Twenty-four individuals with SMI were randomly assigned to either peer navigation or treatment as usual (TAU). Navigators encouraged development of self-management of healthcare through a series of psychoeducation and behavioral strategies. Outcomes included a range of health consequences, as well as health utilization indices. After 6 months, compared to the TAU group, participants receiving the intervention experienced fewer pain and health symptoms. Participants changed their orientation about seeking care to a primary care provider (44.4 % vs. 83.3 %, χ(2) = 3.50, p < .05) rather than the emergency room (55.6 % vs. 0 %, χ(2) = 8.75, p < .01). Therefore, the Bridge intervention demonstrated considerable promise through positively impacting health and healthcare utilization.
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Affiliation(s)
- Erin Kelly
- Health Services Research Center, University of California-Los Angeles, Los Angeles, CA, 90023, USA,
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24
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Ahlers-Schmidt CR, Nguyen M. Parent intention to use a patient portal as related to their children following a facilitated demonstration. Telemed J E Health 2013; 19:979-81. [PMID: 24050608 DOI: 10.1089/tmj.2013.0041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe parent feedback and intention to use the patient portal related to their children's health records after a facilitated learning session. Patient portals are Internet-based, self-service models for health account information and records that allow patients or parents to be more proactive in their healthcare. MATERIALS AND METHODS A navigator demonstrated the patient portal to parents using on-site kiosks at a pediatric clinic. Parents ≥18 years of age completed an institutional review board-approved survey. RESULTS Of those approached, 171 (54%) parents participated in the demonstration; 64 (37%) completed surveys. Average age was 28 years (standard deviation 7), and most were white (26, 40%) or Hispanic (14, 22%). Most (46, 72%) did not know about the patient portal prior to demonstration; of those who did, only five (28%) had used it. Following demonstration, the majority (59, 92%) thought the patient portal was easy to use. Parents planned to view medical records and laboratory results but disliked having separate accounts for each child and the lack of a "symptom checker." Many (44, 69%) planned for future use. The majority (62, 97%) found the navigator helpful, and (37, 58%) wanted access to the patient portal via on-site kiosks. CONCLUSIONS Although most parents had no prior experience with the patient portal, they were satisfied overall with ease of use and offered features. Clinics should consider (1) hands-on demonstrations of the patient portal to encourage understanding and use and (2) alternative access venues if home computers are not available.
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