Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, USA.
Prisma Health Children's Hospital-Upstate, Greenville, SC, USA.
J Community Health. 2023 Dec;48(6):1044-1051. doi: 10.1007/s10900-023-01274-w. Epub 2023 Sep 2.
Approximately 1-in-5 children have a diagnosed mental, behavioral, and/or developmental disorder or delay by age 8 in the United States. Children with such conditions often require complex, complicated diagnostic and specialty care, making them susceptible to repeated referrals and ongoing unmet healthcare needs. Patient navigation programs (PNPs) are designed to integrate care from primary care providers to community-based services, using trained navigators to help patients and their families manage referrals and connect with referred services. This study examines factors associated with repeated referrals to an active PNP to inform ongoing referral patterns and adaptations to standard navigation support within a large healthcare system in South Carolina (SC). Data is sourced from the inception of the PNP in 2017 through 2022, including 15,702 referrals. Overall, 71.07% had no repeated referrals. Children who are older, diagnosed with attention deficit disorder(s), behavioral concerns, depression, multiple referral needs, and insured by Medicaid were found to be most susceptible to repeated referrals. Conversely, children who are non-Hispanic Black, were referred at a well-child visit, and are primarily insured by private insurance or Tricare were least likely to have repeated referrals. Children who are insured by Medicaid are more likely to be younger, identify as non-Hispanic Black, Hispanic, or another race/ethnicity, and have multiple needs at time of initial referral, identifying a potentially compounded risk for those who hold multiple risk factors to experiencing repeated referrals. Findings may inform adaptations to this PNP model to adjust navigator protocol for at-risk populations and equitably optimize referral-to-service connection.
大约有五分之一的美国儿童在 8 岁之前被诊断出患有精神、行为和/或发育障碍或发育迟缓。患有此类疾病的儿童通常需要复杂的诊断和专业护理，这使他们容易反复转诊和持续得不到满足的医疗保健需求。患者导航计划（PNP）旨在将初级保健提供者的护理整合到基于社区的服务中，使用经过培训的导航员帮助患者及其家属管理转诊和与转介服务联系。这项研究调查了与向活跃的 PNP 反复转诊相关的因素，以了解南卡罗来纳州（SC）大型医疗保健系统中持续的转诊模式和对标准导航支持的适应情况。数据来源于 2017 年 PNP 成立至 2022 年，包括 15702 次转诊。总体而言，71.07%的患者没有反复转诊。研究发现，年龄较大、被诊断为注意力缺陷障碍、行为问题、抑郁、有多种转诊需求且由医疗补助计划承保的儿童最容易反复转诊。相比之下，非西班牙裔黑人、在儿童健康检查时被转诊且主要由私人保险或 Tricare 承保的儿童最不可能有重复转诊。由医疗补助计划承保的儿童更可能是年龄较小、非西班牙裔黑人、西班牙裔或其他种族/民族，并且在初次转诊时有多方面的需求，这表明那些有多种风险因素的人存在重复转诊的潜在风险。这些发现可能为调整这种 PNP 模式提供信息，以便为高风险人群调整导航员的协议，并公平地优化转诊与服务的联系。
