Utilizing a patient navigator model to improve pregnancy outcomes among an urban minority population

INTRODUCTION: Previous research has documented the effectiveness of patient navigators in cancer care. Using a similar concept with grant support from the March of Dimes, a community public health clinic in San Francisco established a prenatal patient navigator (PPN) program to increase utilization of prenatal care (PNC), increase early entry into care, help patients keep appointments and ultimately impact disparities in birth outcomes among its predominantly African American, low-income pregnant patients.

PROGRAM: The PPN connects with community based organizations to promote and increase early referrals into PNC, works with the clinic's prenatal team to decrease barriers to care, and enhances relationships between patients and their medical home. The PPN addresses issues around transportation, safety, childcare, health literacy, homelessness, unemployment and healthcare to achieve early and adequate PNC consistent with Healthy People 2010 objectives.

OUTCOMES: Preliminary analysis of PPN impact demonstrates (a) a 48 % increase in the number of women accessing PNC (b) earlier entry into PNC (28 % presenting in 1st trimester before PPN and 61% after), (c) a higher percentage of “adequate” or “adequate +” PNC (28% of patients before PPN and 70% after) and (d) a lower “no-show” rate for PNC appointments. Changes in patient knowledge, attitudes and beliefs regarding PNC will be assessed.

CONCLUSION: Using a patient navigator to support pregnant women living in marginalized communities shows promise towards achieving early entry into PNC, adequate PNC and improved utilization of PNC services. Further refinement of the navigator model within the context of PNC is warranted.