地域医療と健康教育

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Urban Patient Navigator Program Associated with Decreased Emergency Department Use, and Increased Primary Care Use, among Vulnerable Patients

Garbers S, Peretz P, Greca E, Steel P, Foster J, Nieto A6and Arkipoff M

Background: Receiving non-emergent care in the Emergency Department (ED) setting may disrupt continuity of care, may lead to less effective preventive care, and often contributes to overcrowding. Community Health Worker (CHW)-driven patient navigator programs that connect patients to primary care are a promising approach to enhance quality of care for patients and to reduce preventable ED utilization.

Methods: Between July 2010 and June 2011, CHWs delivered services to 5,154 predominantly Spanishspeaking patients within 3 large, urban EDs. An evaluation was conducted to determine whether patient navigation services were associated with decreased ED visits or increased primary care visits. Clinical and administrative data were used to compare the mean number of visits 12 months before and 12 months after navigation.

Results: Eighty-six percent of patients who presented without a primary care provider had a primary care appointment scheduled upon discharge. Among patients with 6-11 ED visits prior to navigation (n=119), the mean number of visits dropped from 7.27 to 3.93 (paired t-test p<0.001). These findings persisted after adjustment for potential confounders including insurance type and age group. Increased use of primary care was concurrent with the observed decreased ED use, although a statistical test of the association between these trends was of borderline significance.

Conclusions: In this population of vulnerable patients who received CHW-driven patient navigation, ED utilization decreased after navigation, particularly among those with highest ED usage. Further research is warranted to determine whether connecting patients to primary care is the driving force behind observed reduced ED utilization and to assess whether there is a concurrent effect on hospital admissions.