Clark Jack A, Parker Victoria A, Battaglia Tracy A, Freund Karen M
Jack A. Clark, PhD, is Medical Sociologist, Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, and Associate Professor, Health Policy and Management, Boston University School of Public Health, Massachusetts. E-mail:
Health Care Manage Rev. 2014 Apr-Jun;39(2):90-101. doi: 10.1097/HMR.0b013e31828da41e.
Patient navigation is a widely implemented intervention to facilitate access to care and reduce disparities in cancer care, but the activities of navigators are not well characterized.
The aim of this study is to describe what patient navigators actually do and explore patterns of activity that clarify the roles they perform in facilitating cancer care.
METHODOLOGY/APPROACH: We conducted field observations of nine patient navigation programs operating in diverse health settings of the national patient navigation research program, including 34 patient navigators, each observed an average of four times. Trained observers used a structured observation protocol to code as they recorded navigator actions and write qualitative field notes capturing all activities in 15-minute intervals during observations ranging from 2 to 7 hours; yielding a total of 133 observations. Rates of coded activity were analyzed using numerical cluster analysis of identified patterns, informed by qualitative analysis of field notes.
Six distinct patterns of navigator activity were identified, which differed most relative to how much time navigators spent directly interacting with patients and how much time they spent dealing with medical records and documentation tasks. Navigator actions reveal a complex set of roles in which navigators both provide the direct help to patients denoted by their title and also carry out a variety of actions that function to keep the health system operating smoothly.
Working to navigate patients through complex health services entails working to repair the persistent challenges of health services that can render them inhospitable to patients. The organizations that deploy navigators might learn from navigators' efforts and explore alternative approaches, structures, or systems of care in addressing both the barriers patients face and the complex solutions navigators create in helping patients.
患者导航是一种广泛实施的干预措施，旨在促进获得医疗服务并减少癌症护理方面的差异，但导航员的活动尚未得到很好的描述。
本研究的目的是描述患者导航员实际做了什么，并探索活动模式，以阐明他们在促进癌症护理中所扮演的角色。
方法/途径：我们对国家患者导航研究项目不同健康环境中运行的九个患者导航项目进行了实地观察，包括34名患者导航员，每人平均观察四次。经过培训的观察员使用结构化观察协议进行编码，同时记录导航员的行动，并撰写定性实地笔记，在2至7小时的观察期间，以15分钟为间隔捕捉所有活动；总共进行了133次观察。通过对实地笔记的定性分析，利用已识别模式的数值聚类分析来分析编码活动的发生率。
确定了六种不同的导航员活动模式，这些模式在导航员直接与患者互动的时间以及处理医疗记录和文档任务的时间方面差异最大。导航员的行动揭示了一系列复杂的角色，其中导航员既提供其头衔所表示的对患者的直接帮助，也开展各种旨在保持卫生系统平稳运行的行动。
努力引导患者通过复杂的医疗服务需要努力解决卫生服务中持续存在的挑战，这些挑战可能使卫生服务对患者不友好。部署导航员的组织可能会从导航员的努力中学习，并探索替代方法、结构或护理系统，以解决患者面临的障碍以及导航员在帮助患者时创造的复杂解决方案。
