Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study

• Type of Material: Article
• Authors: Michal Horny, Emory University; Wiljeana Glover, Babson College; Gouri Gupte, Boston University; Aruna Saraswat, Tufts Medical Center; Varsha Vimalananda, Boston University; James Rosenzweig, Boston University
• Language: English
• Date: 2017-11-21
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12913-017-2700-7
• Title of Journal or Parent Work: BMC Health Services Research
• ISSN: 1472-6963
• Volume: 17
• Start Page: 759
• End Page: 759
• Grant/Funding Information: The study was supported by research grants from The Hearst Foundation and Harvard Pilgrim Health Care Foundation.
• Keywords: Patient navigation; URBAN AFRICAN-AMERICANS; ABNORMAL MAMMOGRAM; BREAST-CANCER; HEALTH-CARE; LOW-INCOME; NURSE CASE MANAGER; Diabetes management; Science & Technology; Health Care Sciences & Services; FOLLOW-UP; GLYCEMIC CONTROL; Patient-centered medical home; RANDOMIZED-CONTROLLED-TRIAL; DIFFERENCE-IN-DIFFERENCES; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Radiology; Health Sciences, Public Health

Abstract

Background: Recent emphasis on value based care and population management, such as Accountable Care Organizations in the United States, promote patient navigation to improve the quality of care and reduce costs. Evidence supporting the efficacy of patient navigation for chronic disease care is limited. The objective of this study was to evaluate the effect of a patient navigation program on medical and administrative outcomes among patients with diabetes in an urban, safety-net hospital clinic setting. Methods: A retrospective cohort study with pre- and post-intervention periods was conducted. Eligible patients were those with A1C ≥ 8.5% and at least one appointment no-show in the previous 12 months. The intervention and reference groups were balanced on observed characteristics and baseline outcome levels using propensity score matching. The effect of patient navigation was isolated using the difference-in-differences approach. Primary outcomes were A1C, low-density lipoprotein cholesterol, triglycerides, random urine microalbumin, the number of scheduled appointments, clinic visits, emergency visits, and inpatient stays, and the percentage of arrivals, cancellations, and no-shows to scheduled appointments. Results: Of 797 eligible patients, 328 entered the navigation program. Matching reduced the sample size to 392 individuals (196 in each group). Patient navigation resulted in improved A1C (-1.1 percentage points; p < .001), more scheduled appointments (+ 5.3 per year; p < .001), more clinic visits (+6.4 per year; p < .001), more arrivals to scheduled appointments (+7.4 percentage points; p =.009) and fewer no-shows (-9.8 percentage points; p < .001). Conclusions: Navigation was associated with improved glycemic control and better clinic engagement among patients with diabetes. Further research is important to identify what features of navigation in diabetes care are critical to achieving success and to understand navigators' role in other settings.