Online Program

A randomized controlled trial of a patient navigator intervention to reduce hospital readmissions in a safety net health care system

Monday, November 4, 2013

Richard Balaban, MD, Somerville Hospital Primary Care, Cambridge Health Alliance, Somerville, MA
Background: This study builds upon a pilot project presented at APHA 2012 in the CHW Section. A CHW involved in the project will be the lead presenter for APHA 2013.

Poor care coordination at hospital discharge can result in avoidable readmissions. The study aims to evaluate the effect of a CHW intervention, the Patient Navigator (PN), on readmission rates and post-discharge health care use in a safety-net population.

Design: Randomized-controlled trial 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.

Methods: Eligible patients were randomly assigned to the PN intervention or usual care. In the PN intervention, a bilingual hospital-based CHW engaged in discharge planning and conducted outreach calls for 30 days after initial discharge. PNs assisted patients with follow-up appointments, obtaining and taking medications, transportation, financial barriers, and linkages to community resources. Socio-demographic, clinical, and utilization data were obtained from electronic medical records.

Results: Total enrolled: 423 PN patients and 513 controls. Readmissions per patient were lower in the PN group compared to controls (0.70 vs. 0.81), as were total hospital days (3.42 vs. 3.59). In addition, more PN patients had a primary care visit within 30 days (77.1% vs. 68.6%).

Conclusion: Preliminary results show a trend toward a reduction in probability of 30-day readmission, number of readmissions, and total hospital days for PN-intervention patients, and a trend toward greater probability of a primary care visit within 30 days of discharge.

Learning Areas:

Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
Describe specific interventions that a CHW/PN can undertake to improve the care transitions process. Describe some of the challenges that patients face in the care transition process, from hospital to home. Define which high risk patients may most benefit to the services provided by a CHW/PN.

Keyword(s): Underserved Populations, Health Care Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the lead investigator for this study and have supervised the Patient Navigators throughout the project.
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.