Factors that predict successful navigation of medically underserved patients by nurse and lay navigators

Background: The Health Resources and Services Administration has administered the Patient Navigator Outreach and Chronic Disease Prevention Demonstration Program (PNDP) since 2008, funding 14 grantees to develop and utilize navigator programs to reduce health disparities among medically underserved communities. Nurses played a critical role in the development and implantation of the navigator programs. Both nurse and lay navigators from the community addressed patients' barriers to care related to lack of knowledge, resources, or insurance by providing education and coordinating services. Under PNDP, the navigation model included cancer and chronic diseases such as diabetes, hypertension, and cardiovascular disease. Methods: PNDP grantees collected information on a series of common data elements related to patient and navigator characteristics, navigator encounters, clinical measures, and health care visits. These data elements provided the basis for the quantitative results of the evaluation and informed predictors of program success as defined by improvements in intermediate health outcomes and clinic performance. Results: Over 10,000 patients were served by PNDP; the primary conditions navigated were cancer and diabetes. We review the characteristics of the patient population, navigators, and encounters, as well as outcomes related to health care visits and clinical measures. We then identify which factors such as patient comorbidities, lack of Medicaid coverage, navigator background (nurse or community health worker), and intervention characteristics (e.g., number of face-to-face encounters) were related to outcome. Conclusion: Findings will help to optimize the effectiveness of future patient navigation programs as interventions for the prevention and treatment of chronic disease and cancer.