Expanding the safety net of specialty care for the uninsured: a case study.
ABSTRACT To describe core principles and processes in the implementation of a navigated care program to improve specialty care access for the uninsured.
Academic researchers, safety-net providers, and specialty physicians, partnered with hospitals and advocates for the underserved to establish Project Access-New Haven (PA-NH). PA-NH expands access to specialty care for the uninsured and coordinates care through patient navigation.
Case study to describe elements of implementation that may be relevant for other communities seeking to improve access for vulnerable populations.
Implementation relied on the application of core principles from community-based participatory research (CBPR). Effective partnerships were achieved by involving all stakeholders and by addressing barriers in each phase of development, including (1) assessment of the problem; (2) development of goals; (3) engagement of key stakeholders; (4) establishment of the research agenda; and (5) dissemination of research findings.
Including safety-net providers, specialty physicians, hospitals, and community stakeholders in all steps of development allowed us to respond to potential barriers and implement a navigated care model for the uninsured. This process, whereby we integrated principles from CBPR, may be relevant for future capacity-building efforts to accommodate the specialty care needs of other vulnerable populations.
SourceAvailable from: Thomas W Concannon[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVES We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. METHODS AND RESULTS We worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs. FINDINGS Reports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports. RECOMMENDATIONS To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.Journal of General Internal Medicine 06/2014; 29(12). DOI:10.1007/s11606-014-2878-x · 3.42 Impact Factor
Health Services Research 02/2012; 47(1 Pt 2):329-36. DOI:10.1111/j.1475-6773.2011.01373.x · 2.49 Impact Factor
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ABSTRACT: To discuss the role and challenges of the oncology nurse navigator working within a multidisciplinary team caring for patients with various types of cancers. Published empirical research and critical analysis articles. The experienced oncology nurse in the role of navigator has the disease-specific knowledge necessary to provide patient-centered care throughout the cancer continuum and promote positive patient outcomes. The role of the oncology nurse navigator has a positive impact on both the patient and the cancer team by providing continuity of care and improved communication. Oncology nurse navigators need a concrete definition of their role and function as they serve not only the patient but the cancer care system in which they work. Acknowledging foundational concepts as a guide, programs can then develop and expand. The role needs to be flexible as the health care system changes. Future development of the role can be guided by oncology nurse navigators who evaluate their programs and identify common challenges and system barriers.Seminars in Oncology Nursing 05/2013; 29(2):105-17. DOI:10.1016/j.soncn.2013.02.005