Impact of a Patient Navigator Program on Hospital-Based and Outpatient Utilization Over 180 Days in a Safety-Net Health System

Background With emerging global payment structures, medical systems need to understand longer-term impacts of care transition strategies. Objective To determine the effect of a care transition program using patient navigators (PNs) on health service utilization among high-risk safety-net patients ov...

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Published in:Journal of general internal medicine : JGIM Vol. 32; no. 9; pp. 981 - 989
Main Authors: Balaban, Richard B., Zhang, Fang, Vialle-Valentin, Catherine E., Galbraith, Alison A., Burns, Marguerite E., Larochelle, Marc R., Ross-Degnan, Dennis
Format: Journal Article
Language:English
Published: New York Springer US 01.09.2017
Springer Nature B.V
Subjects:
Adult
Age
Age Factors
Aged
Ambulatory Care - statistics & numerical data
Chronic obstructive pulmonary disease
Continuity of care
Delivery of Health Care, Integrated
Disease control
Emergency Service, Hospital - statistics & numerical data
Female
Health care
Health services
Heart
Heart diseases
Heart Failure - epidemiology
Hospitals
Humans
Internal Medicine
Length of Stay - statistics & numerical data
Lung diseases
Male
Medicine
Medicine & Public Health
Middle Aged
Navigators
Obstructive lung disease
Original Research
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Patient admissions
Patient Navigation - statistics & numerical data
Patient Readmission - statistics & numerical data
Patient Transfer - organization & administration
Patient Transfer - standards
Patients
Program Evaluation
Pulmonary Disease, Chronic Obstructive - epidemiology
Risk Factors
Safety
Subpopulations
Time Factors
Utilization
patient safety
health care delivery
continuity of care
underserved populations
care transitions
ISSN:0884-8734, 1525-1497, 1525-1497
Online Access:Get full text
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Summary:Background With emerging global payment structures, medical systems need to understand longer-term impacts of care transition strategies. Objective To determine the effect of a care transition program using patient navigators (PNs) on health service utilization among high-risk safety-net patients over a 180-day period. Design Randomized controlled trial conducted October 2011 through April 2013. Participants Patients admitted to the general medicine service with ≥1 readmission risk factor: (1) age ≥ 60; (2) in-network inpatient admission within prior 6 months; (3) index length of stay ≥ 3 days; or (4) admission diagnosis of heart failure or (5) chronic obstructive pulmonary disease. The analytic sample included 739 intervention patients, 1182 controls. Interventions Through hospital visits and 30 days of post-discharge telephone outreach, PNs provided coaching and assistance with medications, appointments, transportation, communication with primary care, and self-care. Main Measures Primary outcomes: (1) hospital-based utilization, a composite of ED visits and hospital admissions; (2) hospital admissions; (3) ED visits; and (4) outpatient visits. We evaluated outcomes following an index discharge, stratified by patient age (≥ 60 and < 60 years), using a 180-day time frame divided into six 30-day periods. Key Results The PN program produced starkly different outcomes by patient age. Among older PN patients, hospital-based utilization was consistently lower than controls, producing an 18.7% cumulative decrease at 180 days ( p  = 0.038); outpatient visits increased in the critical first 30-day period ( p  = 0.006). Among younger PN patients, hospital-based utilization was 31.7% ( p  = 0.038) higher at 180 days, largely reflecting sharply higher utilization in the initial 30 days ( p  = 0.002), with non-significant changes thereafter; outpatient visits experienced no significant changes. Conclusions A PN program serving high-risk safety-net patients differentially impacted patients based on age, and among younger patients, outcomes varied over time. Our findings highlight the importance for future research to evaluate care transition programs among different subpopulations and over longer time periods.
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ISSN:0884-8734
1525-1497
1525-1497
DOI:10.1007/s11606-017-4074-2