Patient navigation across the spectrum of women’s health care in the United States

McKenney, Kathryn; Martinez, Noelle G.; Yee, Lynn M.

doi:10.1016/j.ajog.2017.08.009

Cited by 67 publications

(70 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One mechanism to address these barriers and reduce disparities in PTB prevention is patient navigation. 20 Patient navigation is a patient-centered intervention that uses trained personnel to identify patient-level barriers, including financial, cultural, logistical, attitudinal, and educational obstacles to health care, and then mitigates these barriers to facilitate complete and timely access to health services. [20][21][22][23][24] The core principles of patient navigation involve identifying patientlevel barriers to access, improving timeliness of care, providing health education, and offering social support.…”

Section: Discussionmentioning

confidence: 99%

“…20 Patient navigation is a patient-centered intervention that uses trained personnel to identify patient-level barriers, including financial, cultural, logistical, attitudinal, and educational obstacles to health care, and then mitigates these barriers to facilitate complete and timely access to health services. [20][21][22][23][24] The core principles of patient navigation involve identifying patientlevel barriers to access, improving timeliness of care, providing health education, and offering social support. 21,25,26 A recent Consensus Statement by the National Partnership for Maternal Safety highlighted patient navigation as a potential approach to achieve high-quality and equitable care for all women and to reduce racial and ethnic disparities.…”

Section: Discussionmentioning

confidence: 99%

“…27,28 Patient navigation has improved attendance at postpartum visits compared with a historical cohort who did not receive navigation, suggesting applicability to obstetrics, such as for pregnant women who are recommended 17P. 20,29 Additionally, as comprehensive postpartum care represents an ideal opportunity to optimize postpartum health and educate patients about subsequent risks and preventive care, patient navigation for postpartum women with a PTB may be an opportunity to leverage identified facilitators and address barriers to future PTB prevention. 18 Beyond patient navigation, clinicians may use the findings herein to implement several other strategies to improve uptake of and adherence to PTB prevention strategies.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Barriers and Facilitators to Recurrent Preterm Birth Prevention among Low-Income Women: A Qualitative Study

2018

Self Cite

View full text Add to dashboard Cite

Objective To examine patient perspectives on the experience of preterm birth (PTB) and recommended PTB prevention strategies, focusing on barriers to and facilitators of PTB prevention among low-income women. Materials and Methods This is an observational study using qualitative methodology to investigate barriers to and facilitators of recurrent PTB prevention among low-income pregnant and postpartum women. Participants were either (1) postpartum from an initial spontaneous PTB, (2) pregnant and receiving 17-α-hydroxyprogesterone caproate (17P), or (3) pregnant or postpartum and declined/discontinued 17P. Participants completed individual interviews, and transcripts were analyzed using modified grounded theory techniques. Results Of 33 participants, the majority identified as non-Hispanic black (64%) or Hispanic (27%). Four facilitator themes included patient-centered environment, informed choice, social network, and motivation for a healthy family. Barriers included competing demands, resources, skepticism, and normalization. Three considerations, termed subjective influencers, could support women's decisions to use or decline 17P, including personal beliefs about one's body, the role of the fetus, and beliefs on interventionism. Conclusion The facilitators and barriers identified herein offer insight into the lived experiences of women at a risk of recurrent PTB. Future programs aimed at reducing PTB disparities may benefit from addressing low-income minority women's structural and social determinants of PTB prevention.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Barriers and Facilitators to Recurrent Preterm Birth Prevention among Low-Income Women: A Qualitative Study

2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…34 Patient navigation has also been proposed as a patient-centered approach to improve care and reduce disparities in obstetric and benign gynecologic care. 35 At our institution, we devised a postpartum patient navigation program, Navigating New Motherhood, to increase postpartum care among mainly lowincome and minority women. Patient navigation included multidisciplinary efforts to reduce barriers, frequent face-toface counseling and relationship building, and technology-based assistance with appointment coordination.…”

Section: Discussionmentioning

confidence: 99%

Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance

2018

View full text Add to dashboard Cite

Objective We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance. Study Design This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses. Results Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48–0.99). Conclusion Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit.

show abstract

“…FN is a care management strategy designed to reduce disparities in care (12). Traditional models utilize trained community health workers who assist families in overcoming systems and patient barriers to services over a time-limited period.FN is rooted in the Chronic Care Model (13) and has evidence in multiple diseases as a means to reduce disparities by shortening the interval between discovery of risk (e.g., a positive screening mammogram for breast cancer) and diagnostic ascertainment (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Optimizing Intervention Delivery For Scale: Family Navigatiomentioning

confidence: 99%

Using the Multiphase Optimization Strategy (MOST) Framework to Test Intervention Delivery Strategies: A Study Protocol

Broder‐Fingert¹,

Kuhn

Sheldrick

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Delivery of behavioral interventions is complex, as the majority of interventions consist of multiple components used either simultaneously, sequentially, or both. The importance of clearly delineating delivery strategies within these complex interventions - and furthermore understanding the impact of each strategy on effectiveness - has recently emerged as an important facet of intervention research. Yet, few methodologies exist to prospectively test the effectiveness of delivery strategies and how they impact implementation. In the current paper, we describe a study protocol for a large randomized controlled trial in which we will use the Multiphase Optimization Strategy (MOST) – a novel framework developed to optimize interventions - to test the effectiveness of intervention delivery strategies using a factorial design. We apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. Methods/Design The MOST framework contains three distinct phases: Preparation, Optimization, and Evaluation. The preparation phase for this study occurred previously. The current study consists of the optimization and evaluation phases. Children ages three-to-twelve years-old who are detected as “at-risk” for behavioral health disorders (n=304) at a large, urban federally qualified community health center will be referred to a Family Partner – a bi-cultural, bi-lingual member of the community with training in behavioral health and systems navigation – who will perform FN. Families will then be randomized to one of 16 possible combinations of FN delivery strategies (2x2x2x2 factorial design). The primary outcome measure will be achieving a family-centered goal related to behavioral health services within 90 days of randomization. Implementation data on fidelity, acceptability, feasibility, and cost of each strategy will also be collected. Results from the primary and secondary outcomes will be reviewed by our team of stakeholders to optimize FN delivery for implementation and dissemination based on effectiveness, efficiency, and cost. Discussion In this protocol paper, we describe how the MOST Framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation.

show abstract

Patient navigation across the spectrum of women’s health care in the United States

Cited by 67 publications

References 44 publications

Barriers and Facilitators to Recurrent Preterm Birth Prevention among Low-Income Women: A Qualitative Study

Barriers and Facilitators to Recurrent Preterm Birth Prevention among Low-Income Women: A Qualitative Study

Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance

Using the Multiphase Optimization Strategy (MOST) Framework to Test Intervention Delivery Strategies: A Study Protocol

Contact Info

Product

Resources

About