Use of Patient Navigators as a Strategy to Increase Access to Care for Health Disparities Populations

Background: Since 2008 the Health Resources and Services Administration (HRSA) has administered the Patient Navigator Outreach and Chronic Disease Prevention Demonstration Program (PNDP). The initial cycle of the program funded six grantees to develop and utilize patient navigator programs with the goal of targeting and reducing health disparities among medically underserved populations. While patient navigation has traditionally focused on a cancer prevention and treatment model, the preliminary outcomes of the two year PNDP evaluation suggest that patient navigation is a promising intervention for improving the prevention and treatment of a wide range of chronic diseases. Methods: PNDP grantees collected information on a series of common data elements related to patient characteristics, navigator actions, and patient outcomes related to navigator referrals. These data elements provided the basis for the quantitative results of the evaluation. Results: PNDP navigated 6,567 patients over two years, including 2,983 with a diagnosed chronic disease and 1,347 at high risk for acquiring a chronic disease. Fifty five percent of navigated patients had less than a high school education and 82 percent were either Hispanic or African-American. Fifty five percent spoke English as a second language and 85 percent had a household income of less than $20,000 a year. Navigators identified and addressed numerous barriers to patient care throughout the project. Twenty eight percent of identified barriers involved poor health literacy, 20 percent involved the patient's lack of health coverage or high insurance co-pays, 20 percent involved other patient financial barriers, and 12 percent addressed the lack of a primary care provider. Navigator communications to address those barriers were associated with specific activities. Thirty seven percent of communications were associated with patient education to address health literacy issues, 28 percent were associated with routine follow-up, and 27 percent were associated with providing a patient reminder for an appointment. PNDP shows promising preliminary results regarding patient access to appointments; seventy six percent of patients who were referred by navigators to primary care followed-up with that referral and 68 percent of patients referred to screening services made that appointment. Patient navigators were also instrumental in providing social and psychological support to health disparities patients, especially supporting the behavioral change aspects needed to successfully manage many chronic diseases. Conclusion: While results are preliminary, this study is an important first step for evaluating the effectiveness of patient navigation as an intervention for the prevention and treatment of chronic disease.