Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.
Project Access-New Haven, New Haven, Connecticut.
West J Emerg Med. 2021 Feb 22;22(2):417-426. doi: 10.5811/westjem.2020.9.48105.
Patient navigation programs can help people overcome barriers to outpatient care. Patient experiences with these programs are not well understood. The goal of this study was to understand patient experiences and satisfaction with an emergency department (ED)-initiated patient navigation (ED-PN) intervention for US Medicaid-enrolled frequent ED users.
We conducted a mixed-methods evaluation of patient experiences and satisfaction with an ED-PN program for patients who visited the ED more than four times in the prior year. Participants were Medicaid-enrolled, English- or Spanish-speaking, New Haven-CT residents over the age of 18. Pre-post ED-PN intervention surveys and post-ED-PN individual interviews were conducted. We analyzed baseline and follow-up survey responses as proportions of total responses. Interviews were coded by multiple readers, and interview themes were identified by consensus.
A total of 49 participants received ED-PN. Of those, 80% (39/49) completed the post-intervention survey. After receiving ED-PN, participants reported high satisfaction, fewer barriers to medical care, and increased confidence in their ability to coordinate and manage their medical care. Interviews were conducted until thematic saturation was reached. Four main themes emerged from 11 interviews: 1) PNs were perceived as effective navigators and advocates; 2) health-related social needs were frequent drivers of and barriers to healthcare; 3) primary care utilization depended on clinic accessibility and quality of relationships with providers and staff; and 4) the ED was viewed as providing convenient, comprehensive care for urgent needs.
Medicaid-enrolled frequent ED users receiving ED-PN had high satisfaction and reported improved ability to manage their health conditions.
患者导航计划可以帮助人们克服门诊护理的障碍。人们对这些计划的患者体验了解甚少。本研究的目的是了解参与急诊部（ED）发起的患者导航（ED-PN）干预的美国医疗补助计划参保的频繁 ED 用户的患者体验和满意度。
我们对 ED-PN 计划对过去一年中到 ED 就诊超过 4 次的患者的患者体验和满意度进行了混合方法评估。参与者为英语或西班牙语、新 Haven-CT 居民，年龄在 18 岁以上，且为医疗补助计划参保者。在 ED-PN 干预前后进行问卷调查，并在干预后进行个人访谈。我们分析了基线和随访调查的响应比例。访谈由多位读者进行编码，并通过共识确定访谈主题。
共有 49 名参与者接受了 ED-PN。其中，80%（39/49）完成了干预后的调查。接受 ED-PN 后，参与者报告了较高的满意度、较少的医疗障碍和增强了协调和管理医疗的能力。进行了访谈，直到达到主题饱和。从 11 次访谈中出现了四个主要主题：1）PN 被视为有效的导航者和倡导者；2）健康相关的社会需求是医疗保健的常见驱动因素和障碍；3）初级保健的利用取决于诊所的可及性以及与提供者和工作人员的关系质量；4）ED 被认为是满足紧急需求的便捷、全面的护理。
接受 ED-PN 的医疗补助计划参保的频繁 ED 用户满意度较高，并报告说改善了管理健康状况的能力。
