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Patient Navigation in Pediatrics: A Promising Practice for Eliminating Healthcare Disparities
What was the challenge, opportunity or issue faced?
Patients and families with limited English proficiency (LEP) and/or low levels of acculturation can face multiple barriers when accessing tertiary care at the hospital and in community-based settings for their children with chronic/complex medical needs. Patient navigation has become well recognized as an effective intervention for reducing health disparities in many chronic adult conditions and cancer; and can be an effective tool in a tertiary pediatric care setting.
What did you do to address it?
In 2008, Seattle Children's Hospital launched a pilot program to demonstrate the efficacy of patient navigation in the pediatric healthcare setting. Rather than focusing on specific chronic diseases or cancer, this program has been directed at removing barriers to timely, safe and effective care for Somali and Spanish-speaking families and their children with chronic/complex medical needs. Patient navigators in our program remove these barriers by:
- establishing trust and rapport with families in their own language
- informing families of their rights as patients and the hospital's responsibilities as a healthcare institution
- teaching families how to access hospital and community-based healthcare services, including how to schedule and complete outpatient appointments
- bridging communication between families and providers to assure family understanding of their child's diagnosis and treatment, and provider understanding of the cultural needs of the family
- assisting families with transportation, insurance issues, access to professional interpretation, and providing support in filling prescriptions.
- teaching and empowering families to independently and proactively navigate the US healthcare system successfully to meet their child's ongoing healthcare needs.
In addition, patient navigators teach families how to identify questions they have about their child's health and treatment, and how to advocate for their child's needs to the medical team. When a family demonstrates that they can successfully access pediatric treatment in the hospital and the community on their own and fully participate in interactions with healthcare providers, they "graduate" from the program.
What outcomes were achieved?
Since 2008, 1275 patients have been referred for Patient Navigation services. 56% of families opened to services have mastered all skills and have graduated from the program. 44% have engaged in service and have been closed prior to graduation for reasons including infrequent services, barriers not addressed by navigation services or families were lost to follow up. Bilingual and bicultural staff with Spanish and Somali language skills serve ongoing caseloads in addition to a smaller population speaking languages other than English, Spanish or Somali. These other language groups are served through cross cultural navigation utilizing the skill of the experienced Navigator paired with a certified interpreter in the patient/family's preferred language for care; delivering all of the services of the Patient Navigation program and supporting skill building for the patients and families served.
Outcomes for this program are consistent with the premise that patient navigation reduces disparities.
An outside evaluation showed the following outcomes:
- Inpatient admission rates were lower for children after their involvement with patient navigators as compared to before they were a part of the program. The average length of stay for children with admissions was lower after their involvement with patient navigators as compared to before.
- Children with navigators had a lower proportion of missed opportunities for care than they did before their involvement with the program and as compared to children in their same language groups without navigators and to the English-speaking Medicaid population.
- Feedback from patient navigator families responding to the Family Experience Survey was generally positive; and staff and faculty satisfaction serving families in these language groups was significantly higher on most measures in a survey after 3 years of program services compared to before navigators were in place.
In a recent case referred by inpatient providers, a navigator worked to support a family with little to no literacy in English and their language of origin (an African dialect of lesser diffusion). The navigator worked with an interdisciplinary team to support and assure understanding and safe delivery of prescribed medications and dietary guidelines after their child's discharge home. This 9 year old, admitted with progressive kidney disease and potential need for dialysis; is now seen outpatient with all disease markers improving and reporting all around good health. The patient navigator's strong advocacy upon recognition that parents were relying on memory alone (size, color and prescribed frequency of multiple medications) to assure safe medication delivery; greatly improved the collective support from the medical team, pharmacy and a community based home visiting nurse to assure that this patient and family were able to provide safe and reliable care for their child upon discharge.
About Seattle Children's Hospital
Seattle Children's is the pediatric and adolescent referral center for Washington, Alaska, Montana and Idaho founded in 1907. With 403 licensed beds and over 400,000 outpatient visits per year we deliver superior patient care and advance new treatments through pediatric research. We are also the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine.
From 2012 through 2017 the average number of limited English speaking (LEP) families was 12.3%. The top five languages were Spanish at 7.5%, Vietnamese and Somali at 0.7%, Cantonese at 0.5% and ASL at 0.3%