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

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 limit...

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Autores principales: Horný, Michal, Glover, Wiljeana, Gupte, Gouri, Saraswat, Aruna, Vimalananda, Varsha, Rosenzweig, James
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5699176/
https://www.ncbi.nlm.nih.gov/pubmed/29162073
http://dx.doi.org/10.1186/s12913-017-2700-7
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author Horný, Michal
Glover, Wiljeana
Gupte, Gouri
Saraswat, Aruna
Vimalananda, Varsha
Rosenzweig, James
author_facet Horný, Michal
Glover, Wiljeana
Gupte, Gouri
Saraswat, Aruna
Vimalananda, Varsha
Rosenzweig, James
author_sort Horný, Michal
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-017-2700-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-56991762017-12-01 Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study Horný, Michal Glover, Wiljeana Gupte, Gouri Saraswat, Aruna Vimalananda, Varsha Rosenzweig, James BMC Health Serv Res Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-017-2700-7) contains supplementary material, which is available to authorized users. BioMed Central 2017-11-21 /pmc/articles/PMC5699176/ /pubmed/29162073 http://dx.doi.org/10.1186/s12913-017-2700-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Horný, Michal
Glover, Wiljeana
Gupte, Gouri
Saraswat, Aruna
Vimalananda, Varsha
Rosenzweig, James
Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study
title Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study
title_full Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study
title_fullStr Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study
title_full_unstemmed Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study
title_short Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study
title_sort patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5699176/
https://www.ncbi.nlm.nih.gov/pubmed/29162073
http://dx.doi.org/10.1186/s12913-017-2700-7
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