Community)Health)Navigator) Intervention)for)Patients)with) - PowerPoint PPT Presentation

Community)Health)Navigator) Intervention)for)Patients)with) Multiple)Chronic)Diseases:) Results)from)the)ENCOMPASS) Pilot)Study March)6,)2020 Jennifer)Malkin,)Dailys)Garcia)Jorda,)Natalie)C.)Ludlow,) David)Campbell,)Gabriel)Fabreau,)Kerry)A.)McBrien

Pr Presenter:(Jennifer(Ma Malkin • Speakers(Bureau/Honoraria:(N/A • Consulting(Fees:(N/A • Grants/Research(Support:(N/A • Patents:(N/A • Other:(N/A

Mosaic'Primary'Care'Network' (MPCN) • Located'in'Calgary’s'Northeast 91'clinics • 296'physicians • Serve'over'300,000'patients • • SocioEeconomically'disadvantaged'neighbourhoods • High'proportion'of'new'immigrants,'ethnic'minorities • High'burden'of'chronic'diseases • Patients'face'challenges'accessing'health'care

Co Community)H y)Health)N )Navigators) (CHNs) • While)not)a)health)care)professional,)a)CHN) is)a)patient;centered)care)provider)with) strong)roots)in)the)community. • A)trusted)member)of)the)primary)care)team,) a)CHN)can)accompany)patients)through)their) health)care)journey. • CHNs)can)support)patients)in)three)areas) that)contribute)to)better)management)of) chronic)health)conditions: 1. System)navigation 2. Patient)self;management 3. Social)connection 4

Evidence(ba Ev base sed, d,pr progr gram,the theory Community(Health( Long(Term(Outcomes: How(It(Works: Intermediate(Outcomes: Navigator(Activity: Provide(information(to(health( care(provider Improve(patient(communication( with(health(care(provider Translation,(interpretation Provide(information(to(health( Patient(experience care(provider Enable(patient(understanding Provide(education( Patient(activation Translation,(interpretation (written/verbal) Provider(experience Provide(education( Improve(health(status/health( Advocate(for(patient (written/verbal) related(quality(of(life Appropriate(medication(use Provide(social(support Advocate(for(patient Connect(patient(with(resources( Weight (social,(financial) Connect(patient(with( Blood(pressure Motivational(interviewing,(goal( Decrease(adverse(outcomes resources((social,(financial) Support(selfEmanagement setting A1C Motivational(interviewing,( Illness(exacerbations Verify(adherence(to(care(plan goal(setting Smoking(cessation Verify(adherence(to(care(plan Decrease(emergency(room(and( Facilitate(health(care(referrals hospital(use Facilitate(health(care(referrals Optimize(use(of(primary(care Schedule(and(monitor( Reduce(duplication(of(care Coordination,(navigation Schedule(and(monitor( appointments appointments Provider(attachment Facilitate(transportation Facilitate(transportation 5

EN ENCOM OMPASS)* EN EN hancing CO COM munity health) through) P atient)navigation,) A dvocacy)and) S ocial) S upport ENCOMPASS) ENCOMPASS)Trial ENCOMPASS)Expansion Pilot)Study 2)Primary)Care)Clinics 20)Primary)Care)Clinics 3)Additional)PCNs 2017<2019 2018<2021 2019<2022 Cluster<randomized)to) Single)arm)observational) immediate)vs.)delayed) study) implementation A)one*year)pilot)study)exploring)the)feasibility)and)effectiveness)of)a)community) health)navigation)program)for)adults)with)multiple)chronic)conditions)began)in)June) 2017 6

Quantitative)Methods Patient)health)surveys) (baseline,)67 and)127months) Pa • Sociodemographic)characteristics • Health)questions • Patient7reported)outcomes)(health)status;)experience)of)care;)patient) activation;)social)support) Administr Ad trati tive)data) (17year)pre7 and)post7enrollment) • ED)visits • Hospitalization)admissions) An Analysis • Pre7post)outcomes)tested)in)patient)health)survey)and)administrative)data Wilcoxon)signed7rank)test • Mcnemar test) • 7

Qualitative.Methods 16. 16.se semiAst structured. intervie in iews 5. 2. 2. 3. 4. Patients Managers Nurses Physicians CHNs 4. 4.fie field ld.obse servatio ions 4.CHNs.were.observed.for.3.hours.each An Analysis Interviews.and.observation.field.notes.were.transcribed,.coded,.and.organized.into. • themes.using.thematic.analysis. Consensus.in.coding,.theming,.and.definitions.achieved.as.part.of.an.iterative.process. • among.the.complete.research.team.. 8

Patient'Demographic'Characteristics'(n=21) 62%'of'patients'self;identified'as'female 52%'of'patients'had'an'average'household' income'less'than'$30,000/year 48%'of'patients'had'less'than'a'high'school' diploma'as'their'highest'education'level Median'number'of'chronic' conditions/patient'was'6'(range=' Mean'age'of'patients'was'60 1;11) 9

Patient'Reported'Outcomes' Variable Baseline+– 68months+(N=14) Baseline+– 12+months+(N=16) Baseline+ Median+ p1value p1value* Baseline 61months Baseline* 121months (IQR)+ (BL1 61 (BL1121 Median*(IQR)* Median (IQR) Median*(IQR)* Median (IQR)* (n=21) months) months) EQ85D8 0.7*(0.4) 0.68*(0.6) 0.8*(0.4) 0.29 0.67*(0.6) 0.7*(0.4) 0.25 5L EQ+VAS 50.0*(30.0) 50.0*(27.5) 50.0*(25.0) 0.64 50.0*(28.75) 50.0*(20.0) 0.47 mMOS8 37.5*(75.1) 56.3*(67.2) 75.0*(40.6) 0.19 37.5*(74.2) 81.3*(43.8) 0.0042* SS PACIC 1.8*(0.5)* 1.9*(0.7) 2.5*(1.2) 0.22 1.9*(0.6) 1.9*(0.7) 0.30

ED#Visits#and#Hospital#Admissions#(N=21) 12*months1pre 12*months1post Variable p*value Proportion/Median1(IQR) Proportion/Median1(IQR) ED1visit1(Y/N)1 47.6&% 38.1&% 0.48 #1ED1visits 0.0&(2.0) 0.0&(1.0) 0.81 Hospital1admission1(Y/N) 19.0&% 14.3&% 0.56 #1Hospital1admissions 0.0&(0.0) 0.0&(0.0) 0.81 Total1#1ED1&1Hospital 0.0&(3.0) 0.0&(2.0) 0.92 11

Qualitative#data#revealed# Ba Barri rriers#to# o#Ca Care At#the#patient#level :#Poverty;#lack# At That’s'the'biggest'barrier'that'I’ve'seen'with'people,'like'healthy'eating' of#social#support;#cultural#barriers# and'fitness,'is'the'money'involved A CHN# (health#literacy;#language#issues;# Even'if'the'family'doctor'explains'to'me'the'process,'I'do'not'know'how' lack#of#knowledge#of#the#health# to'go'there'and'deal'with'the'medical'staff'on'my'own= Patient# care#system) Our'visits'are'structured'to'kind'of'communicate'what'we'want'to' At At#the#provider#level :#Poor# communicate'but'sometimes'we'don’t'have'the'time'to'listen'to'what' communication#(short# the'patient'really'wants= RN# consultation#times) We'have'six'and'seven'physicians'even'more'they'have'up'to'like'30=40' patients'so'they'only'get'to'spend'15'minutes'with'each'patient,'so'we' focus'entirely'on'the'biomedical,'but'sometime'we'do'forget'that'you' know,'there'are'also'barriers'that’s'preventing'them'from'doing'this= RN At#the#system#level :#Fragmented# At healthcare#system#(lack#of# So,'when'I'did'my'complex'care'plan'and'I'found'that'they' knowledge#of#the#health#care# needed'a'number'of'referrals'to'specialists,'they'were'very' system) hesitant'in'attending'those'appointments= Physician 12

CHN$Program$was$ Ac Acceptable I"feel"my"patients"are"happy,"they"feel"they"are"getting"the,"a"wide"range"of" Physicians$noted$positive$ care"from"uh"different"places,"yeah. […]"I"am"very"happy"and"I’m"thankful"for" impacts$and$were$ you"for"providing"this"service"for"us"and"even"my"patients"I’ve"found"they" welcoming$of$CHNs$in$ were"very"thankful,"yeah."[…]"I"appreciate"the"program." their$practices They"[CHNs]"are"very"professional,"very"helpful,"very"uh"astute,"you"know" theyBthey"take"it"very"seriously"and"I"like"how"meticulous"they"are." I"think"this"project"is"very"good"and"useful"as"I"follow"up"with"them,"they" Patients$identified$benefits$ continue"to"care"about"me."The"services"were"great. The"benefits"for"me"were" and$positive$experiences more"follow"up"for"my"health,"my"treatment"and"better"communication" between"me"and"my"doctor." the"doctors"I’ve"dealt"with"a"few"times"directly,"where"I"attend"the"patient"visits" CHNs$found$their$role$to$ with"the"patient,"um"and"they"are"always"really"supportive,"and"excited"to"see" be$rewarding$and$ the"CH[N]"there impactful$for$both$patients$ I"think"[…]"there’s"support"in"that"way"because"he"[doctor]"knows"who"I"am," and$clinicians and"when"I'm"in"the"room,"[…]"he’ll"ask"me,"like"[CHN"name]"do"you"have"any" questions"for"me?"Do"you"have"questions"for"the"patient?”" 13