Patient Navigation in a Tertiary Pediatric Healthcare Setting: A - - PowerPoint PPT Presentation

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Patient Navigation in a Tertiary Pediatric Healthcare Setting: A - - PowerPoint PPT Presentation

Nov 13, 2022 106 likes •350 views

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 Childrens Hospital, Seattle

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Center for Diversity and Health Equity

Douglass L. Jackson, DMD, MS, PhD

Chief, Center for Diversity and Health Equity Seattle Children’s Hospital, Seattle WA

Patient Navigation in a Tertiary Pediatric Healthcare Setting: A Promising Practice for Eliminating Healthcare Disparities

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Center for Diversity and Health Equity

  • 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

  • utpatient utilization
  • To see how provider’s perceptions of

caregiver preparedness to care for their child when they return home changes with patient navigation

Patient Navigation: A Promising Practice for Eliminating Healthcare Disparities

Today’s Objectives:

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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.

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Center for Diversity and Health Equity

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
  • ur patient population
  • Provided over $113 million in uncompensated care in FY 2012
  • Culture of Continuous Performance Improvement

Seattle Children’s

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Center for Diversity and Health Equity

Who do we serve? FY2012 Limited English Proficient Patients (LEP)

15% of all families at Children’s in FY12 were LEP

The language diversity of patients at Seattle Children’s: FY12

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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

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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
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Center for Diversity and Health Equity

How do patient navigators help?

  • Establishing trust and rapport with patient in their
  • wn 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

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Center for Diversity and Health Equity

  • 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

Patient Navigation at Seattle Children’s

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Center for Diversity and Health Equity

  • 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

  • utpatient utilization
  • To see how provider’s perceptions of

caregiver preparedness to care for their child when they return home changes with patient navigation

Patient Navigation: A Promising Practice for Eliminating Healthcare Disparities

Today’s Objectives:

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Center for Diversity and Health Equity

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%

Outcomes Evaluation

Patient Demographics

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Center for Diversity and Health Equity

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%

Parent Demographics

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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)
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Center for Diversity and Health Equity

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%

English-speaking Medicaid missed appointment rate 11%

18.5% 16.8% 10.3% 8.3% 8.5% 3.5%

*p=0.004 *p<0.001

Outcomes: Missed Outpatient Appointments

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Center for Diversity and Health Equity

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

Outcomes: Completed Specialty Referrals

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Center for Diversity and Health Equity

Quality Metrics: ED time to MD by language group

Inpatient Admissions per Year

Outcomes: Inpatient Utilization

N size Before Patient Navigation After Graduation P-Value Inpatient admissions / 300 days

83 3.68 1.01 P< .001

Average Length of Stay

N size Before Patient Navigation After Graduation P-Value ALOS

27 14.8 6.5 P< .001

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Center for Diversity and Health Equity

  • 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

  • utpatient utilization
  • To see how provider’s perceptions of

caregiver preparedness to care for their child when they return home changes with patient navigation

Patient Navigation: A Promising Practice for Eliminating Healthcare Disparities

Today’s Objectives:

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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

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Center for Diversity and Health Equity

Results: Use of Professional Interpretation During Hospital Admission

Outcomes: Coordination of Care

0% 10% 20% 30% 40% 50% Somali Excellent Somali Very Good Spanish Excellent Spanish Very Good

FY09 FY11

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Center for Diversity and Health Equity

Results: Use of Professional Interpretation During Hospital Admission

Outcomes: Caring for the Child at Home

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Somali Strongly Agree Somali Somewhat Agree Spanish Strongly Agree Spanish Somewhat Agree

FY09 FY11

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Center for Diversity and Health Equity

Results: Use of Professional Interpretation During Hospital Admission

Outcomes: Who to Call, or Turn To For Help

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Somali Strongly Agree Somali Somewhat Agree Spanish Strongly Agree Spanish Somewhat Agree

FY09 FY11

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Center for Diversity and Health Equity

  • 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

  • utpatient utilization
  • To see how provider’s perceptions of

caregiver preparedness to care for their child when they return home changes with patient navigation

Patient Navigation: A Promising Practice for Eliminating Healthcare Disparities

Summary of Objectives:

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Center for Diversity and Health Equity

Quality Metrics: ED time to MD by language group

Acknowledgements

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

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Center for Diversity and Health Equity

Please contact The Center for Diversity and Health Equity Seattle Children’s Hospital 206-987-3506 diversity@seattlechildrens.org

For more information