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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adequate Insurance.

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Strategy. Patient Navigators

Approach. Promote the use of family navigator programs

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Overview. Patient navigators, sometimes called systems navigators, provide sensitive assistance and care coordination, determining individual barriers and guiding patients through available medical, insurance, and social support systems. Navigators are usually employed by hospitals for clinics, and may be fully integrated into a primary care team. Hospitals and clinics generally try to hire navigators that come from the same communities as their patients. Navigators are most commonly employed in cancer care, often serving low income for patients facing challenges. (Robinson-White 2010*). Most clinic-based navigators serve low income individuals in urban settings and work with pre existing clients. (Hou 2015*).

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Consultation (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of family navigator programs established in healthcare settings serving populations experiencing barriers to care. (Measures the availability and reach of navigation services)
  • Number of family navigators hired and trained to provide care coordination. (Assesses the workforce capacity to meet patient needs)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of family navigators who complete a comprehensive training program on care coordination and community resources. (Assesses workforce readiness to provide high-quality services)
  • Percent of navigator encounters that include an assessment of non-medical needs. (Reflects the holistic and patient-centered approach to care)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of community partnerships established by navigator programs to expand the network of resources and referral options. (Reflects efforts to build a robust ecosystem of support)
  • Number of healthcare providers and staff trained on the role and value of family navigators. (Builds organizational capacity to integrate and leverage navigation services effectively)

OUTCOME MEASURES:

  • Number of emergency department visits for hospitalizations avoided due to proactive support and care coordination from family navigators. (Shows the potential for improved health outcomes and cost savings)
  • Number of patients who report improved quality of life and reduced stress as a result of support from family navigators. (Reflects the broader psychosocial and well-being impact of navigation)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of eligible patients in a healthcare system for community who are referred to for engaged with family navigation services. (Assesses the penetration and reach of navigation programs)
  • Percent of family navigators who share the same characteristics as the population served. (Reflects the representation within the navigation workforce)

OUTCOME MEASURES:

  • Percent decrease in health gaps for chronic disease management and outcomes among patients served by navigation programs. (Measures the potential for advancing health outcomes)
  • Percent increase in patient activation and self-efficacy scores following participation in navigation services. (Reflects the long-term impact on patient empowerment and capacity to navigate the health system independently)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Robinson-White 2010 - Robinson-White S, Conroy B, Slavish KH, Rosenzweig M. Patient navigation in breast cancer: A systematic review. Cancer Nursing. 2010;33(2):127-40.

2 Hou 2015 - Hou S-I, Roberson K. A systematic review on US-based community health navigator (CHN) interventions for cancer screening promotion - Comparing community-versus clinic-based navigator models. Journal of Cancer Education. 2015;30(1):173-186.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.