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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Care Coordination.

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Strategy. Patient Navigators

Approach. Incorporate patient navigators into hospitals and clinics so families receive the support they need

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Overview. Patient navigators, sometimes called systems navigators, provide assistance and care coordination, determining individual challenges and guiding patients through available medical, insurance, and social support systems. Patient navigators are usually employed by hospitals or clinics, and may be fully integrated into a primary care team. Hospitals and clinics generally try to hire patient navigators that come from the same communities as their patients. Patient navigators are most commonly employed in cancer care, often serving low income patients.[1] Most clinic-based patient navigators serve low income individuals in urban settings and work with pre-existing clients.[2] Patient navigators may increase access to care by improving scheduling and completion of appointments for children with autism spectrum disorder and increasing immunization and preventive care for urban adolescents.[3,4]

Evidence. Scientifically Rigorous Evidence. Strategies based on scientifically rigorous evidence are proven effective across multiple robust studies. While success is highly likely, local impact may vary. Monitor outcomes and use data to tailor these strategies to the community's unique needs.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Patient navigator activity and workload logs
  • Patient and family satisfaction surveys
  • Patient-reported measures on perceived challenges

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

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

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

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of hospitals and clinics that integrate patient navigators into interdisciplinary care coordination teams for pediatric patients and families. (Measures team-based care transformation)
  • Number of pediatric patients and families served by designated patient navigators who provide individualized, whole-person support for accessing and coordinating needed services. (Shows reach of navigation intervention)

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

  • Percent of hospitals and clinics that integrate patient navigators into interdisciplinary care coordination teams for pediatric patients and families. (Measures team-based care transformation)
  • Percent of pediatric patients and families served by designated patient navigators who provide individualized, whole-person support for accessing and coordinating needed services. (Shows reach of navigation intervention)

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

  • Number of educational opportunities provided by Title V that provide ongoing training and support to patient navigators to build their care coordination and systems navigation skills. (Measures investment in workforce development)
  • Number of regional pediatric care coordination networks and population health initiatives led by Title V that include patient navigators as core team members. (Shows integration of navigation into system-level improvement efforts)
  • Number of communities that achieve measurable improvements in pediatric health outcomes and family well-being through the adoption of patient navigator-supported care coordination models. (Demonstrates population health impact)
  • Number of case studies and learning collaboratives that document and share best practices in patient navigation for pediatric care coordination. (Indicates knowledge generation and diffusion of the model)

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

  • Percent of educational opportunities provided by Title V that provide ongoing training and support to patient navigators to build their care coordination and systems navigation skills. (Measures investment in workforce development)
  • Percent of regional pediatric care coordination networks and population health initiatives led by Title V that include patient navigators as core team members. (Shows integration of navigation into system-level improvement efforts)
  • Percent of communities that achieve measurable improvements in pediatric health outcomes and family well-being through the adoption of patient navigator-supported care coordination models. (Demonstrates population health impact)
  • Percent of case studies and learning collaboratives that document and share best practices in patient navigation for pediatric care coordination. (Indicates knowledge generation and diffusion of the model)

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.
[3] Roth BM, Kralovic S, Roizen NJ, et al. Impact of autism navigator on access to services. Journal of Developmental & Behavioral Pediatrics. 2016;37(3):188–195.
[4] Szilagyi PG, Humiston SG, Gallivan S, et al. Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates. Archives of Pediatrics & Adolescent Medicine. 2011;165(6):547-553.

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.