A Realist Evaluation Analysis of a Novel Multi-Faceted Inpatient Patient Navigation Program.

Abstract

Children of color and from low-income families experience disparities in hospital care and outcomes. This study examined the experiences of parents and providers who participated in a novel patient navigation program designed to address these disparities. Between April and October 2018, we conducted semistructured interviews with parents enrolled in the Family Bridge navigation pilot study, and inpatient care providers. Each set of interviews was thematically coded and analyzed according to the Realist Evaluation Framework of context, mechanism and outcomes; to identify how and when the program worked, for whom, and with what results. Of 60 parents enrolled in the intervention, 50 (83%) completed an interview. All enrolled children had public insurance; 66% were Hispanic, 24% were non-Hispanic Black, and 36% of parents preferred Spanish for communication. Of 23 providers who completed an interview, 16 (70%) were attending physicians. Parents identified 4 contexts influencing intervention effectiveness: past clinical experience, barriers to communication, access to resources, and timing of intervention delivery. Four mechanisms were identified by both parents and providers: emotional support, information collection and sharing, facilitating communication, and addressing unmet social needs. Parent-level outcomes included improved communication, feeling supported, and increased parental knowledge surrounding the child's care and the health system. Provider-level outcomes included providing tailored communication and attending to family nonmedical needs. This study provided insight into the mechanisms by which an inpatient navigation program may improve communication, support, and knowledge for parents of low-income children of color, both directly and by changing provider behavior.