Patient Navigation: A Call to Action

Abstract

Patient is the new buzzword in health care. Patient navigators assist patients in overcoming barriers to the timely receipt of health care services. Although there are only a few published studies that describe or evaluate current programs that employ patient navigators (see Dohan & Schrag, 2005, for a review of the literature), the concept of patient navigation is presumed to be a promising strategy to reduce racial and ethnic disparities in health outcomes. On June 29, 2005, President Bush signed into law the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 (P.L. 109-18). The new law authorizes the appropriation of $25 million over five years for demonstration programs to provide patient navigator services to improve health outcomes. As of June 2006, Congress had not yet appropriated funds, but its chief sponsor, Senator Robert Menendez (D-NJ), remained sanguine about the law's prospects for an appropriation in 2006 or in the future, given its strong bipartisan support (personal communication with Karissa Willhite, legislate aide to Senator Menendez, June 1, 2006). As this act represents a large, coordinated federal commitment to patient navigation and will likely lead to establishing standards of practice, it is imperative that social workers understand the new law and what is at stake for social work. It also is essential for social workers to reflect on what is known about current patient navigator programs and initiatives so that they can anticipate issues that may arise, help shape the discussion, and assure a place at the table for social workers as new federally sponsored programs are developed and implemented. Accordingly, in this article I review the evidence from current patient navigation programs, describe the provisions of the new law, and identify the key issues that require proactive attention by social workers. The first patient navigator program dates to 1990 and is ascribed to work by Harold Freeman, a physician who formerly practiced at Harlem Hospital Center in New York (Freeman, Muth, & Kerner, 1995). With initial funding from the American Cancer Society, Dr. Freeman and colleagues developed the Breast Health Patient Navigator Program, which uses patient navigators to assist women who seek diagnosis and treatment of breast cancer. In Freeman's conceptualization, patient navigators help patients who have abnormal findings obtain prompt follow-up care by eliminating obstacles to diagnosis and treatment. Dr. Freeman does not prescribe any formal educational requirements for the position (Breast Health Patient Navigator Resource Kit, 2005). In his current role as associate director of the National Cancer Institute (NCI) of the National Institutes of Health and director of NCI's Center to Reduce Cancer Health Disparities, Dr. Freeman oversees the Patient Navigator Research Program. This program has funded eight grants over a five-year period, from FY 2006 through FY 2010, and aims to determine the efficacy and cost-effectiveness of patient navigator interventions (NCI Awards, 2005). The target population for the interventions is patients with an abnormal finding on a screening for one of four cancer types:breast, cervical, prostate, or colorectal. Despite the proliferation of patient navigation programs across the country, fundamental questions remain unresolved. There is no standard definition of patient navigation (Dohan & Schrag, 2005), nor is there a presumption about what type of personnel (for example, professional or layperson; social worker, nurse clinician, health educator, or case manager; paid worker or volunteer) is best suited to perform patient navigation activities. The lack of a uniform definition likely explains the diversity of approaches used in patient navigation programs. In their review of 11 programs, Dohan and Schrag found that seven programs used lay workers and only four used professionals. The Patient Navigator act does not prescribe any qualifications for patient navigators except that they have direct knowledge of the communities they serve. …