AcademyHealth Annual Research Meeting
Boston MA
June 2727-29 2010
Improving Chronic Disease
Management and Preventive Care
through PatientPatient-Centered
Navigation
Elizabeth Whitely,
y PhD RN; Rachel M. Everhart, MS;
Voila Rendon; Ana Barrett
R
Research
h Objective
Ob
Patient-centered navigation

Chronic disease management
 Diabetes
 Hypertension

Cancer screening
 Breast
 Cervical
 Colorectal
Denver Health
Medical Center
911 Medical
Response
p
Correctional
Care
Denver
Public Health
Community
Health Centers
Denver CARES
Denver Health
Foundation
Rocky Mountain
Regional Trauma
Center
Rocky Mountain Poison
and Drug Center
Denver Health
Medical Plan
School-based
School
based
Health Centers
Rocky Mountain
Center for Medical
Response to Terrorism
S d D
Study
Design


June 1, 2008 – June 30, 2010
Nonrandomized cross sectional
analysis
 3 clinics
li i with
i h navigators
i
vs. 6 usuall
care clinics
 Clinics
Cli i selected
l t db
based
d on readiness
di
 Baseline and study end (6/1/2010)

Electronic clinical registries
Intervention

Patients with diabetes or
hypertension
 Cancer screening needs


IImprove adherence
dh
tto plan
l off care
Identify
y and reduce barriers to care

Scheduling care


Financial
Transportation


Language
Lack of
g
understanding
P
Population
l
Studied
S d d

5500 patients eligible for navigation
 8500 total patients (6.5%
(6 5% panel attrition)
Primary Insurance
Uninsured
45%
M di id
Medicaid
22%
Medicare
24%
Commercial
4%
Other
5%
P
Population
l
Studied
S d d

1825 patients enrolled (12/31/2009)
Enrolled Patient Demographics
Race/Ethnicity
Hispanic
55%
Black
19%
White
22%
Female
63%
Age
35 – 49 yrs
21%
50 – 64 yrs
49%
65 + yrs
26%
Outcomes

Diabetics
 HgbA1c
g
< 7%
 LDL < 100 mg/dL
 BP < 140/90 mmHg

H
Hypertensives
t
i
 BP < 140/90 mmHg

Cancer Screening
 Mammogram in the past 2 years (F 42-69 yrs)
 Pap smear in the past 3 years (F 21-64
21 64 yrs)
 Colorectal cancer screening (51-75 yrs)
Diabetes - HgbA1c < 7%
Navigated
70%
60%
%
50%
40%
Control
OR: 1.07
(0 96 1 20)
(0.96-1.20)
OR: 1.06
((0.93-1.20))
42%
34%
40%
30%
33%
20%
Baseline
Follow-Up
Follow
Up
Diabetes - LDL < 100
Navigated
Control
80%
70%
%
60%
50%
OR: 1.14
(1.01-1.28)
54%
51%
60%
56%
OR: 1.18
OR
1 18
(1.05-1.32)
40%
30%
Baseline
Follow-Up
Follow
Up
Diabetes - Blood Pressure < 140/90
Navigated
100%
90%
%
OR: 1.06
(0 93 1 21)
(0.93-1.21)
78%
80%
70%
70%
Control
69%
60%
74%
OR: 1.19
OR
1 19
(1.05-1.36)
50%
Baseline
Follow-Up
Follow
Up
Hypertension - Blood Pressure < 140/90
Navigated
Control
90%
80%
70%
OR: 1.05
(0.98-1.13)
59%
60%
58%
50%
68%
64%
OR: 1.21
OR
1 21
(1.13-1.30)
40%
Baseline
Follow-Up
Follow
Up
Breast Cancer Screening
Navigated
Control
80%
70%
%
60%
OR: 1.19
((1.10-1.28))
61%
54%
50%
49%
45%
40%
OR: 1.30
OR
1 30
(1.19-1.43)
30%
Baseline
Follow-Up
Follow
Up
Cervical Cancer Screening
Navigated
90%
80%
OR: 0.76
(0 71 0 81)
(0.71-0.81)
76%
70%
Control
77%
76%
70%
OR: 1.05
(0.98-1.12)
60%
50%
Baseline
Follow-Up
Follow
Up
Colorectal Cancer Screening
Navigated
Control
70%
60%
%
50%
40%
OR: 1.21
(1.13-1.30)
41%
37%
54%
52%
OR: 1.10
(1.03-1.18)
30%
20%
Baseline
Follow-Up
Follow
Up
C l
Conclusions

Improvements in clinical outcomes
 Blood pressure control
 Breast cancer screening
 Cervical cancer screening

Next steps
 Fi
Finall analysis
l i with
i h study
d end
dd
data
 Patient and staff satisfaction
 Impact on urgent, emergent and inpatient
utilization related to hypertension and diabetes
S
Significance
f


Patient-centered navigation should
be considered when planning care
coordination and management
programs
Patient-centered
Patient
centered navigators can be
an efficient part of the Medical Home
team

Funding provided by the Office of
Health Disparities
Disparities, Colorado
Department of Public Health and
Environment
Rachel Everhart, MS
D t T
Data
Team Administrator
Ad i i t t
Denver Community Health Services
rachel.everhart@dhha.org