265339 Feasibility of employing a Patient Navigator to reduce hospital readmissions: A randomized quality improvement study

Monday, October 29, 2012 : 9:10 AM - 9:30 AM

Richard Balaban, MD , Somerville Hospital Primary Care, Cambridge Health Alliance, Somerville, MA
Amanda Horowitz, MSW, MPH , Ambulatory Administration, Cambridge Health Alliance, Somerville, MA
Background: Safety-net patients experience 30-day readmission rates ranging from 11% to 24%. Health systems that care for these patients need to develop cost-effective care transition strategies to meet this population's diverse needs.

Objective: To test the feasibility, acceptance, and preliminary effect on readmissions of using a hospital-based Community Health Worker (CHW) as a Patient Navigator (PN) to support the care transition process.

Design: Patient-level randomized quality improvement study comparing usual care to a model in which a PN provides supportive post-discharge services. An academic safety-net medical center and affiliated primary care practices.

Intervention: High risk patients with an in-network PCP discharged to home from the medical service. Inpatient introductory visit and 30 days of post-discharge telephonic patient support by a bilingual CHW/PN to assist in coordinating post-discharge medical care.

Measures: Patient acceptance, fidelity to the protocol, intervention intensity, and primary care, emergency department and inpatient care use.

Results: Roughly 70% of patients accepted at least one post-discharge CHW/PN call, but the planned intervention protocol was completed for just 38% of patients. Hospital readmission rates were lower among PN patients (15.4%) compared to usual care (17.9%); but the difference was not statistically significant. Patient enrollment is continuing and updated data will soon be available.

Conclusion: Under emerging performance-based payment systems, identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of safety-net delivery systems. This study provides evidence that hospital-based community health workers may represent a feasible strategy for improving transitional care among vulnerable populations.

Learning Areas:
Administer health education strategies, interventions and programs
Assessment of individual and community needs for health education
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
1. Demonstrate the feasibility of employing a CHW/PN to reduce hospital readmissions. 2. Describe specific interventions that a CHW/PN can undertake to improve the care transitions process. 3. Describe some of the challenges involved that a CHW/PN may face in participating in the process to improve care transitions.

Keywords: Community Health Promoters, Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked with Dr. Balaban on this project and am well versed in the content and results. In addition, I have worked with Patient Navigators and Community Health Workers for the last 4 years in primary care and hospital settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.