Patient Navigation: Justifiable Popularity?
Patient navigation in pediatric emergency medicine has become increasingly popular in the last decade. In recent years, three major initiatives related directly to patient navigation have been funded by the United States government (Wells, 2011). The study explored whether the increasing popularity associated with patient navigation in pediatric emergency medicine is justified, based on efficacy data. A cohort of 100 subjects whose minor children sought care at the Memorial Hermann Hospital Children's Emergency Department were enrolled in the study. Subjects were interviewed on site at the time of enrollment, then again, over the phone, one week after their child was discharged from the pediatric emergency department. Specifically, the study sought to determine 1) whether patient navigation impacted the arrival rate at a follow up visit with a physician outside of the emergency department, and 2) whether demographic characteristics (specifically, age, gender and ethnicity) impacted the aforementioned arrival rate. The results of the study demonstrated that patient navigation does not impact the arrival rate at follow up visits and that none of the demographic characteristics studied impacted the arrival rate at follow up visits. Study limitations included sample bias (sample represents subjects whose children sought care at only one emergency department and worked with only one patient navigator), response bias (while 100 subjects enrolled in the study, 16 did not pick up the phone to answer interview questions and 5 picked up the phone but were unwilling to answer interview questions), measurement tool bias (the study did not explore why the subjects did not arrive/did not arrive at follow up appointments) and the fact we did not explore case severity (both the acutely ill and those seeking primary care in the emergency department were scheduled for follow up visits but we do not know whether acuity had an impact on arrival rates). A follow up study on the efficacy of patent navigation, conducted a multiple emergency departments where subjects work with multiple patient navigators, using arrival rates as the outcome variable, stratified by case severity should be conducted in order to determine whether patient navigation is effective for some acuity groups. Additionally, it will be important to ask subjects why they did or did not arrive at their follow up visits. Subjects who did not arrive at their follow up visits may indicate that they did not arrive for a variety of different reasons ranging from car trouble, financial issues associated with paying a co-pay, the children feeling better and not needing to see a doctor to no intention of arriving at scheduled follow up visit. Finally, face to face interviews may help negate the impact of response bias. The results of the study do not support the development and maintenance of patient navigation programs in pediatric emergency departments, if organizations were interested in efficacy, as defined by follow up visit compliance only. ^
Health Sciences, Public Health|Health Sciences, Health Care Management
Hodges, Sarah, "Patient Navigation: Justifiable Popularity?" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3641716.