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1. Patients who were seeing multiple specialists 2. Patients who were using internal resources frequently (high staff demands, frequent phone calls or visits) 3. Patients requiring social services 4. Patients needing a difficult or complex referral 5. Patients who were homebound 6. Patients who were having family communication issues 7. Patients requiring mental health or pain management coordination Data Description Examples Meeting notes Project meetings conducted before, during, and at the end of the project • Agenda and minutes • E-mail communications • Original grant application Navigator log Tool used to track activities of navigator, focus navigator debriefings, and select patients for interviews. • Medical conditions of patients • Number of contacts made • Services provided • Patient barriers • Community resources accessed Navigator debriefings 1-hour telephone sessions every 2–4 weeks with research team member • Audio recordings and transcriptions Helped navigator reflect on her work and allowed her to discuss experiences with patients so detailed notes were not needed Patient interviews In-depth telephone interviews (15–45 min) with 15 patients or their family members • Audio recordings and transcriptions Conducted at the end of the project. Patients were purposely selected by the research team after review of navigator logs to maximize richness and variability of patient experiences Included patients who did not need many services Physician interviews In-depth, face-to-face interviews (20–40 min) with all participating physicians • Audio recordings and transcriptions Conducted at the beginning and end of the project Issue Assistance Provided Choosing, understanding, and using health coverage • Assisted with medical claim submissions • Assisted with charity care applications • Reviewed coverage of long-term care policies • Reviewed Medicare requirements and provided assistance in obtaining specialized equipment • Obtained financial resources and information on social security benefits • Identified pharmaceutical companies that provide free/low-cost drugs • Researched options for coverage of organ transplantation • Identified and referred patients to low-cost/free dental care • Identified and referred patients to free bereavement counseling • Assisted in applying for loan for air conditioning installation for disabled • Obtained letter of necessity for physician Choosing, using, and understanding health providers and services • Made referrals for home health aides • Identified adult day care centers and agencies providing live-in caregivers for elderly • Obtained information on assisted living facilities and low-cost senior housing • Obtained and relayed information on guardianship and power of attorney • Identified resources to help visually impaired patients • Facilitated a blind patient's move to subsidized senior housing • Obtained Meals on Wheels for patients • Provided information on transportation services for doctor's appointments • Obtained information on medic alert devices • Located and referred to alcohol and substance abuse treatment programs • Made referrals for child special education services • Identified and referred patients to child and geriatric psychiatrists • Identified and referred patients to difficult to find specialists (eg, autoimmune specialist, physical therapy for balance problems) • Located and coordinated low cost housekeeping services Making decisions about treatment • Provided emotional support and encouragement in obtaining psychological counseling • Obtained advance directives from patients • Supported parents in sending child to residential treatment facility Managing conditions and care received by multiple providers • Followed up with specialists to obtain test results and reports • Relayed information between patients/family members and physicians • Assisted with phone calls for deaf patient going for surgery Patient characteristics and background • Indigent, disabled, 61-year-old single woman • Has diabetes, coronary artery disease, congestive heart failure requiring implantable defibrillator, severe arthritis, and severe dental problems • Subsisted on cereal because that was all she could eat and afford • Window air conditioning unit broke and she was having difficulty breathing in the summer heat Patient barriers • Financial: could not afford food, dental work, psychiatric counseling, installation of donated central air conditioning unit • Psychosocial: lacked social support, had fear and mistrust of dentists, depressed (“All I was doing was waiting to die.”) • Transportation: had difficulty driving the long distance to see a psychiatrist and could not afford gas Services provided by patient navigator • Obtained Meals on Wheels, resolving a catchment area dispute between 2 offices • Provided an application for charity care for dental work • Identified a psychiatrist that accepted Medicare for treatment of anxiety and depression and arranged an appointment • Obtained application for interest-free loan for air conditioner installation and coordinated a letter of necessity from patient's physician • Provided emotional support and encouragement to see the dentist • Negotiated counseling at a nearby church when the patient declined treatment from a psychiatrist and had difficulty driving to the appointment
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