The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials

Ali-Faisal, Sobia; Colella, Tracey J.F.; Medina-Jaudes, Naomi; Scott, Lisa Benz

doi:10.1016/j.pec.2016.10.014

Cited by 106 publications

(127 citation statements)

References 76 publications

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“…PN was shown to have early success in helping with the accrual of minorities to clinical trials by increasing awareness and access and reducing barriers to participation . Most reviews have focused on the efficacy of PN in various settings across the breast cancer continuum, on female cancers across the cancer continuum, or on improving screening rates and the time to diagnosis . Other reviews have shown that PN improves patient‐reported outcomes such as patient satisfaction …”

Section: Introductionmentioning

confidence: 99%

“…16 Most reviews have focused on the efficacy of PN in various settings across the breast cancer continuum, 17,18 on female cancers across the cancer continuum, 19 or on improving screening rates and the time to diagnosis. 20,21 Other reviews have shown that PN improves patient-reported outcomes such as patient satisfaction. [22][23][24] Few systematic reviews have evaluated the efficacy of PN across the cancer continuum, including all cancer types and populations.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Bernardo

Zhang

Hery

et al. 2019

Cancer

139

166

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Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost‐effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost‐effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow‐up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost‐effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost‐effectiveness and more rigorous reporting of study designs and results in published articles.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Bernardo

Zhang

Hery

et al. 2019

Cancer

139

166

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“…Initially, patient navigators were used to support vulnerable patient populations at risk of adverse health outcomes with remaining engaged in care and accessing needed services . Much of the literature on patient navigation is focused on adultsand specific patient populations such as cancer, diabetes, and HIV; however, the literature is emerging surrounding patient navigator roles in the context of supporting pediatric patients in their transition to adult care . A recent environmental scan of pediatric patient navigator programs in Canada identified 23 operational navigator programs .…”

Section: Introductionmentioning

confidence: 99%

Impact of a transition program with navigator on loss to follow‐up, medication adherence, and appointment attendance in hemoglobinopathies

Allemang

Allan

Johnson

et al. 2019

Pediatric Blood & Cancer

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Background Transition from pediatric to adult care is a period of high risk for loss to follow‐up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow‐up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer. Procedure A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n = 51) and one year after (n = 61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient. Results The transition program with TN reduced loss to follow‐up from 29% to 7% (P = 0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to ≥4 days/week; exposure to the program was independently associated with such improvement (P = 0.047). A trend toward improvement or maintenance of ≥90% attendance to appointments was observed (P = 0.096). Frequency of hospitalization was not significantly different between the two cohorts (P = 0.985). Conclusions A transition program with TN significantly reduced loss to follow‐up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.

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“…Most research on navigators comes from adult populations with significant health concerns, such as cancer or severe mental illness. 63,64 Pediatric navigation research has addressed chronic disease management (eg, asthma and diabetes) 65 and the promotion of early testing and intervention, 66 with few studies that are focused on mental health. 46,54 Given the limited research on the use of navigators for children with mental health concerns, we draw from research from other settings and populations to fill gaps and highlight the potential for navigators to improve mental health treatment and outcomes for children.…”

Section: Navigation Outcomes Researchmentioning

confidence: 99%

“…77,78 Navigation programs have also been associated with increased service use, including linkages to care, adherence to recommended testing and treatment, and timeliness in obtaining health care services, even for patients who are at high risk for delays in care. 44,45,64,[79][80][81] In a meta-analysis of randomized controlled trials (RCTs) of navigation to improve health care use (most were focused on adult patients with cancer), pooled analysis revealed that navigation increased the likelihood of health screening uptake by 2.5 times and attendance at recommended appointments by almost 3 times. 64 Similarly, in an RCT of adults with serious mental illness who were presenting for emergency care, patients assigned to a navigator group were more likely to access primary care after a psychiatric crisis compared with those assigned to a control group.…”

Section: Navigation Outcomes Researchmentioning

confidence: 99%

Increasing Mental Health Engagement From Primary Care: The Potential Role of Family Navigation

Godoy

Hodgkinson

Robertson³

et al. 2019

Pediatrics

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Early engagement in mental health intervention is critical, yet the vast majority of children who are experiencing mental health concerns are not receiving needed services. Pediatric primary care clinics have been recognized as an ideal setting in which to identify and address mental health problems early, although engagement in mental health services within primary care and in community-based settings remains low. Navigators, or individuals with experience in navigating the mental health system, have been highlighted as promising partners in efforts to improve engagement in mental health services. Navigation has a growing body of research support among adults and in targeting medical concerns, but there has been limited research on integrating family navigators into pediatric primary care settings to address mental health concerns. Despite this gap in the evidence base, we believe there is significant promise for the use of this model in addressing children’s mental health needs. In this report, we discuss factors contributing to high levels of unmet mental health needs and low levels of engagement in mental health services, the role that navigators can play in increasing engagement in mental health care, and implications and recommendations related to integrating mental health–focused family navigators into pediatric primary care settings.

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The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials

Cited by 106 publications

References 76 publications

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Impact of a transition program with navigator on loss to follow‐up, medication adherence, and appointment attendance in hemoglobinopathies

Increasing Mental Health Engagement From Primary Care: The Potential Role of Family Navigation

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