Table 3 Characteristics of system navigation models and their purpose
From: Navigation delivery models and roles of navigators in primary care: a scoping literature review
Study | Location of study | Components of the model | Purpose | Reported or perceived outcomesa |
|---|---|---|---|---|
Studies of lay person navigators (n = 12) | ||||
Retkin et al., 2013 | New York City, US | Name: Healthcare Legal Partnership (HeLP) | To improve health and well-being of vulnerable communities by integrating legal assistance in patient navigation | PO - improvements in general health and wellness, patients who were connected to legal services reported positive impacts on finances and even improved compliance with medical appointments and treatment PNO - increased understanding of the law and skills to address patient’s needs |
Type of Navigator: Lay patient navigator trained in legal issues with support of attorneys | ||||
Population: People with Cancer and HIV | ||||
Esperat et al., 2012 | Texas, US | Name: Transformacion Para Salud (Transformation for Health) | A chronic disease self-management model to develop a culturally sensitive intervention to facilitate patient behavior changes | PO - improvements in general health and wellness, Improved self-efficacy, self-management or empowerment HSO - Reduction in emergency room and/or hospital use |
Type of Navigator: Certified community health workers | ||||
Population: Underserved populations with chronic diseases | ||||
Layne et al., 2012 | Atlanta, US | Name: Good Samaritan Health Centre | To assist new patients in establishing a healthcare home, to prevent disease, detect health conditions at an earlier stage and provide more successful treatment, and reduce preventable ED visits | PO- Increased access to care HSO - Reduction in emergency room and/or hospital use |
Type of Navigator: Patient Navigator assisting with financial and medical system practices working with primary care providers | ||||
Populations: Uninsured adult patients living in poverty with no regular primary care provider | ||||
Spiro et al., 2012 | Massachusetts, US | Name: The MGH Chelsea community health improvement team | To provides support for everyone involved in patient care: patients, providers, the community at large, and the internal CHW staff | PO - improvements in general health and wellness, increased patient satisfaction PNO - satisfaction with navigation programs, opportunity to redevelop as professionals |
Type of Navigator: Community Health Worker | ||||
Population: Vulnerable sub-populations including refugees/immigrants, Latinos, an those facing significant economic, education and health challenges | ||||
Brown et al., 2011 | Brooklyn, US | Name: Healthy Programs Brooklyn | To increase access to care, improve health education and ease navigating the health care system | PNO - increased knowledge and skills |
Type of Navigator: Trained lay navigators | ||||
Population: Residents living in New York City housing authority developments | ||||
Linkins et al. 2011 | Minnesota, US | Name: Stay Well, Stay Working (SWSW) | To offer working persons with serious mental illness a comprehensive set of health, behavioral health, and employment support services | PO - improvements in general health and wellness, increased access to care, increased employment and reduced financial stresses, reduced numbers of mental health patients who applied for disability benefits, and a significantly higher percentage of behavioural health claims compared to controls |
Type of Navigator: Navigators trained in vocational rehabilitation serving an employment support role | ||||
Population: Social Security Disability beneficiaries with psychiatric illnesses | ||||
Carroll et al., 2010 | New York, US | Name: Cancer Patient Navigation Program | To assess and alleviate barriers to adequate health care | PO - Negative experiences were reported in a cancer patient navigation program delivered by community health workers (CHW), from a variety of settings including primary care |
Type of Navigator: Community Health Workers | ||||
Population: Newly diagnosed patients with breast or colorectal cancer | ||||
Gimpel et al., 2010 | Dallas, US | Name: Project Access Dallas | To provide access to health and social care for the “working poor” who are ineligible for existing, publicly-funded health care | PO - improvements in general health and wellness, Improved self-efficacy, self-management or empowerment, working poor served in one study noted that services were now affordable |
Type of Navigator: Community Health Workers (CHWs) | ||||
Population: Uninsured, low income residents requiring access to health care | ||||
Clark et al., 2009 | Boston, US | Name: Boston REACH 2010 Breast and Cervical Cancer Coalition Women’s Health Demonstration Project | To identify and reduce medical and social obstacles to breast cancer screening and following up abnormal results | PO - Increased access to care |
Type of Navigator: Case managers | ||||
Population: Women of African descent | ||||
Mayhew et al., 2009 | London, UK | Name Integrated Care Co-ordination Service (ICCS) | To provide supports to older adults to prevent hospital admissions and early admissions to long-term care | HSO - Reduction in emergency room and/or hospital use |
Type of Navigator: Care coordinators | ||||
Population: Adults age 65 and over with one or more chronic conditions | ||||
McCloskey et al., 2009 | New Mexico, US | Name: LA VIDA (lifestyle and values impacting diabetes awareness) | To reduce barriers to health and social services and supports for Hispanics living with diabetes | PO - improvements in general health and wellness, Improved self-efficacy, self-management or empowerment, Increased access to care PNO - empowered in their community advocacy role and some were promoted into supervisory roles |
Type of Navigator: Promotores du salud (community members who act as healthcare navigators) in a community health centres | ||||
Population: Hispanics with diabetes or at risk for diabetes | ||||
Bradford et al., 2007 | Portland, Seattle, Boston, Washington, US | Name: HIV Systems Navigation | To increase engagement and retention in HIV primary medical care for individuals previously unconnected or tenuously connected to care | PO - improvements in general health and wellness, Increased access to care |
Type of Navigator: Non-clinical staff with Bachelor’s degree in social science or healthcare | ||||
Population: HIV-infected individuals with co-occurring mental and substance abuse disorders | ||||
Studies of Nurse Navigators (n = 10) | ||||
Wolff et al. 2009; Boult et al. 2010; Foret Giddens et al. 2009; Boyd et al. 2007 | Three mid-Atlantic health regions, US | Name: Guided Care Model | To improve the quality of life, quality of care, and efficiency of resource use for medically complex older adults To support caregivers of older adults with complex health-related needs; to improve patients’ health and the well-being of their families and friends | PO- Improved self-efficacy, self-management or empowerment, increased access to care, improvements in caregiver depression and strain PNO - satisfaction with navigation programs, increased trust, increased communication between primary care providers and community services, and among providers |
Type of Navigator: Guided Care Nurses (registered nurses) and interdisciplinary primary care team | ||||
Population: Medically complex older adults and caregivers of older adults | ||||
Maeng et al. 2013 | Rural central Pennsylvania, US | Name: Proven Health Navigator (PHN) | To provide chronic care and patient-centred primary care services in rural communities | PO- Increased access to care HSO- Reduction in emergency room and/or hospital use |
Type of Navigator: Nurse case managers | ||||
Population: Adults with severe or multiple chronic conditions requiring case management | ||||
Kramer et al. 2012 | Large Mid-western city, US | Name: Safe Mom, Safe Baby (SMSB) | To provide interdisciplinary case management to support pregnant women experiencing Intimate Partner Violence (IPV) | PO - improvements in general health and wellness |
Type of Navigator: Registered nurse and domestic violence advocate | ||||
Population: Marginalized women who self-disclose Intimate Partner Violence (IPV) who are pregnant or recently pregnant | ||||
Burton et al., 2010 | US | Name: Patient-centered chronic care management | To educate as a support to patients and their families, and facilitate access to community resources | PO- Improved self-efficacy, self-management and empowerment |
Type of Navigator: Nurse case managers | ||||
Population: Patients with primary immunodeficiency disease (PIDD) | ||||
Williams et al., 2010 | UK | Name: Community Matrons | To improve patient self-management and education, and enhance co-ordination between primary and social care. | PO - improvements in general health and wellness, access, patient advocacy, and psychosocial support. |
Type of Navigator: Advanced Practice Nurse | ||||
Population: people living with long-term conditions in the community | ||||
McCann & Clark, 2005 | UK | Name: Community mental health nurses | To promote wellness and caring | Outcomes not measured |
Type of Navigator: Community mental health nurses (registered nurses) | ||||
Population: Young adults with early episode of schizophrenia | ||||
Pfeffer et al., 1995 | San Diego, US | Name: Special Infectious Disease (SPID) Case Management Model | A framework to provide cost-effective, accessible, continuous, quality health care. | PO - Increased access to care |
Type of Navigator: Advanced Practice (Nurse practitioners) | ||||
Population: Veterans with HIV-related illnesses and AIDS | ||||
Studies of Social Work Navigators (n = 1) | ||||
Ferrante et al., 2010 | US | Name: Patient Navigator pilot | To help patients use the health care system efficiently in primary care practices | PO - Increased access to care |
Type of Navigator: Social worker | ||||
Population: Elderly patients (mostly female) | ||||
Studies of Student Navigators (n = 1) | ||||
Bishop et al. 2009 | Charlottesville, US | Name: Charlottesville Health Access (CHA) | To provide access to health and social services and connect homeless adults to permanent primary care services | None reported |
Type of Navigator: Medical and nursing students trained in navigation | ||||
Population: Homeless adults | ||||
Studies of Navigation Delivered by Teams of Health Professionals and Lay Persons (n = 6) | ||||
Tejeda et al. 2013 | Chicago, US | Name: Chicago Patient Navigation Research Program (PNRP) | To identify and remove barriers faced by African-American and Latina women receiving cancer diagnoses and treatment | PO - Increased access to care |
Type of Navigator: Lay navigators and clinical social workers | ||||
Population: African-American and Latina women with breast or cervical cancer diagnoses without prior treatment | ||||
Mullins et al., 2012 | Baltimore, US | Name: Community Partnership Program | To foster community collaboration and raise awareness of the need to improve health in the community and to identify and connect patients to existing resources and services | PO increased patient satisfaction, increased access to care PNO - satisfaction with navigation programs, increased communication between primary care providers and community services |
Type of Navigator: Health care professionals, community health workers, faith-based ministries and community leaders | ||||
Population: African American and Hispanic communities | ||||
Bohman et al., 2011 | Houston, US | Name: The Texas Demonstration to Maintain Independence and Employment | To coordinate a set of health benefits and employment supports to help low-income, working adults maintain their employment and remain independent of publicly funded disability assistance | PO- improvements in general health and wellness, increased patient satisfaction, increased access to care, no differences in employment, hours worked or earnings |
Type of Navigator: Nurses, social worker and vocational specialists | ||||
Population: Uninsured working adults with chronic mental, behavioral and physical health conditions | ||||
Hendren et al. 2011 | Rochester, US | Name: Patient Navigation Research Program (PNRP) | To understand health disparities related to barriers to care for newly-diagnosed cancer patients | None reported |
Type of Navigator: Community health workers (CHW) and hospital and primary care teams | ||||
Population: Newly diagnosed breast and colorectal cancer patients | ||||
Palinkis et al., 2011 | California, US | Name: Multi-faceted Depression and Diabetes Program (MDDP) | To prevent depression relapse through chronic illness management interventions including problem solving treatment and patient/family education | None reported |
Type of Navigator: Patient navigator, social worker, psychiatric consultant | ||||
Population: Hispanic diabetic patients with depression | ||||
Tataw et al. 2011 | Los Angeles, US | Name: South Central Los Angeles Health Care Alliance (SCHCA) | To provide case management support aimed at empowering families to navigate the health care system | PO- Improved self-efficacy, self-management or empowerment, increased patient satisfaction, increased access to care |
Type of Navigator: Community health workers (CHW) and pediatric primary care teams | ||||
Population: Low-income urban children and families without a regular source of healthcare | ||||
Studies of Navigation Delivered by Teams of Health Professionals (n = 3) | ||||
Anderson et al. 2009; Anderson et al. 2009 | Western Canada | Name: Sooke Navigator Project | To provide a community-based intervention to support access to mental health and social support services | PNO - increased communication between primary care providers and community services, increased trust |
Type of Navigator: Two navigators with training in social work and psychiatric rehabilitation | ||||
Population: Adults with mental health and addictions | ||||
Halkitis et al. 2010 | New York City, US | Name: AIDS Service Organizations (ASO) | To raise the level of health, mental health, and quality of life for HIV-positive women | None reported |
Type of Navigator: Case manager and interdisciplinary team of physicians, nurses, mental health professionals, social workers, and community representatives | ||||
Population: Black and Latina HIV-positive women | ||||