Patient Navigation in a Tertiary Pediatric Healthcare Setting: A Promising Practice for Eliminating Healthcare Disparities Douglass L. Jackson, DMD, MS, PhD Chief, Center for Diversity and Health Equity Seattle Children’s Hospital, Seattle WA Center for Diversity and Health Equity
Patient Navigation: A Promising Practice for Eliminating Healthcare Disparities Today’s Objectives: • To understand how patient navigation principles were adapted to meet the needs of Seattle Children’s • To appreciate the impact patient navigation can have on inpatient and outpatient utilization • To see how provider’s perceptions of caregiver preparedness to care for their child when they return home changes with patient navigation Center for Diversity and Health Equity
Patient Navigation, Some Background • Patient navigation has shown great promise for improving health care quality and outcomes for underserved populations. • A patient navigator is a lay health worker who provides culturally competent assistance in guiding patients through their health care encounters. • Patient navigators do this by providing practical education, “coaching”, and assisting with care-related logistics. Center for Diversity and Health Equity
Seattle Children’s About Us • We are the specialty medical center that serves Washington, Alaska, Montana, and Idaho • 250-bed facility • 290,671 ambulatory visits in FY 2012 • Medicaid and state-funded health insurance comprises 50% of our patient population • Provided over $113 million in uncompensated care in FY 2012 • Culture of Continuous Performance Improvement Center for Diversity and Health Equity
The language diversity of patients Who do we serve? at Seattle Children’s: FY12 FY2012 Limited English Proficient Patients (LEP) 15% of all families at Children’s in FY12 were LEP Center for Diversity and Health Equity
Patient Navigation at Seattle Children’s • The program started with the goal of helping Spanish- speaking and Somali patients and their families: ü overcome barriers to care ü increase access to care ü improve the quality of their care • Operational support was provided by a partnership between Seattle Children’s and the Pacific Hospital Preservation and Development Authority Center for Diversity and Health Equity
Patient Navigation at Seattle Children’s Program Staffing: - Two Spanish-speaking patient navigators - One Somali patient navigator - One program supervisor Center for Diversity and Health Equity
How do patient navigators help? • Establishing trust and rapport with patient in their own language • Assuring that families understand their child’s diagnosis, the care being delivered, how to ask questions and advocate for their child • Teaching families how to successfully navigate the healthcare system on their own • Assuring that providers understand the families’ cultural needs Center for Diversity and Health Equity
Patient Navigation at Seattle Children’s • Referral from community or hospital physician, nurse or social worker • Child with chronic condition (e.g. diabetes) or medically complex condition • Identified language need (Spanish or Somali) • Low acculturation, with culture, religion or communication impacting care Center for Diversity and Health Equity
Patient Navigation: A Promising Practice for Eliminating Healthcare Disparities Today’s Objectives: • To understand how patient navigation principles were adapted to meet the needs of Seattle Children’s • To appreciate the impact patient navigation can have on inpatient and outpatient utilization • To see how provider’s perceptions of caregiver preparedness to care for their child when they return home changes with patient navigation Center for Diversity and Health Equity
Outcomes Evaluation Patient Demographics N=210 Gender Male 61% Median age (range) 5.8 years (newborn, 18 years) Language Spanish 57% Somali 36% Indigenous Languages 5% (Mam, Mixteco, Mije, Quiche, Triqui Baja) Other 2% Payor Medicaid /government funded 98% Commercial insurance 2% Center for Diversity and Health Equity
Parent Demographics Results: Participant Characteristics Parent education level (N=90) Somali Spanish Never attended school or only attended kindergarten 25% 1% Grades 1 through 8 55% 53% Grades 9 through 11 0% 29% Grade 12 or GED 15% 11% Some college/technical school or more 5% 6% Center for Diversity and Health Equity
Outcomes Evaluation • Number of missed appointments • Number of completed specialty referrals • Rate of annual inpatient admission • Inpatient average length of stay (days) Center for Diversity and Health Equity
Outcomes: Missed Outpatient Appointments 20% 18.5% 18% 16.8% 16% 14% English-speaking Medicaid missed appointment rate 11% 12% 10% 10.3% 8.3% 8.5% 8% 6% *p=0.004 3.5% 4% 2% *p<0.001 0% Center for Diversity and Health Equity
Outcomes: Completed Specialty Referrals Results: Completed Specialty Referrals Population Proportion with No Appt All Ambulatory Appts 20% Somali – No Patient Navigator 19% Somali – Patient Navigator 5% Spanish – No Patient Navigator 17% Spanish – Patient Navigator 9% Reflects a PCP referring a child to Seattle Children’s Hospital for specialty care. Reasons referrals do not result in an appointment: • family failure to schedule appointments • duplicate referrals • inappropriate referrals Center for Diversity and Health Equity
Outcomes: Inpatient Utilization Quality Metrics: ED time to MD by language group Inpatient Admissions per Year N size Before Patient After Graduation P-Value Navigation Inpatient admissions / 83 3.68 1.01 P< .001 300 days Average Length of Stay N size Before Patient After Graduation P-Value Navigation ALOS 27 14.8 6.5 P< .001 Center for Diversity and Health Equity
Patient Navigation: A Promising Practice for Eliminating Healthcare Disparities Today’s Objectives: • To understand how patient navigation principles were adapted to meet the needs of Seattle Children’s • To appreciate the impact patient navigation can have on inpatient and outpatient utilization • To see how provider’s perceptions of caregiver preparedness to care for their child when they return home changes with patient navigation Center for Diversity and Health Equity
Evaluation Process: Providers An evaluation of changes in provider attitudes over time (2009-2011) about how prepared Somali and Spanish- speaking families are to care for their child when they return home: i. The coordination of care for the child once they have returned home ii. Knowing how to care for the child after they return home iii. Knowing who to call or where to turn for help after returning home Center for Diversity and Health Equity
Results: Use of Professional Interpretation Outcomes: Coordination of Care During Hospital Admission 50% Somali 40% Excellent Somali Very 30% Good Spanish 20% Excellent 10% Spanish Very Good 0% FY09 FY11 Center for Diversity and Health Equity
Results: Use of Professional Interpretation Outcomes: Caring for the Child at Home During Hospital Admission 100% 90% Somali 80% Strongly Agree 70% Somali 60% Somewhat Agree 50% 40% Spanish Strongly Agree 30% 20% Spanish 10% Somewhat Agree 0% FY09 FY11 Center for Diversity and Health Equity
Results: Use of Professional Interpretation Outcomes: Who to Call, or Turn To For Help During Hospital Admission 100% 90% Somali 80% Strongly Agree 70% Somali 60% Somewhat Agree 50% 40% Spanish Strongly Agree 30% 20% Spanish 10% Somewhat Agree 0% FY09 FY11 Center for Diversity and Health Equity
Patient Navigation: A Promising Practice for Eliminating Healthcare Disparities Summary of Objectives: • To understand how patient navigation principles were adapted to meet the needs of Seattle Children’s • To appreciate the impact patient navigation can have on inpatient and outpatient utilization • To see how provider’s perceptions of caregiver preparedness to care for their child when they return home changes with patient navigation Center for Diversity and Health Equity
Acknowledgements Quality Metrics: ED time to MD by language group Patient Navigators: Ali Adem, Blanca Fields, Ivonne Poveda-Leyva Sarah Rafton, MSW Michelle Tolman, MPH Mon T. Myaing, PhD Chuan Zhou, PhD Beth E. Ebel, MD, MSc, MPH Rita Mangione-Smith, MD, MPH Seattle Children’s Pacific Hospital Preservation and Development Authority Seattle Children’s Center for Diversity & Health Equity Center for Diversity and Health Equity
For more information Please contact The Center for Diversity and Health Equity Seattle Children’s Hospital 206-987-3506 diversity@seattlechildrens.org Center for Diversity and Health Equity
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