Translating the patient navigator approach to meet the needs of primary care.

BACKGROUND: Helping patients navigate the complex and fragmented US health care system and coordinating their care are central to the patient-centered medical home. We evaluated the pilot use of a patient navigator (PN), someone who helps patients use the health care system effectively and efficiently, in primary care practices.
METHODS: This study was a cross-case comparative analysis of 4 community practices that implemented patient navigation. Project meeting notes, PN activity logs and debriefings, physician interviews, and patient/family member interviews were analyzed using a grounded approach.
RESULTS: Seventy-five mostly female, elderly patients received navigation services from a social worker. The PN typically helped patients obtain social services and navigate health coverage and complex referrals. Availability of workspace for PN, interaction with practice members, and processes used for selecting and referring patients affected PN collaboration with and integration into practices. Patients found PN services very helpful, and physicians viewed the PN as someone carrying out new tasks that the practice was not previously doing.
CONCLUSIONS: Patient navigation in community primary care practices is useful for patients who have complex needs. Integrating such services into primary care settings will require new practice and payment models to realize the full potential of integrated patient navigation services in this setting.