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Published on: April 22, 2015
A hybrid type I randomized effectiveness-implementation trial of patient navigation to improve access to services for
Sarabeth Broder-Fingert1,2, Morgan Walls3, Marilyn Augustyn4
1Department of Pediatrics, Boston University School of Medicine, Boston, MA, 02114, USA. Sarabeth.Broder-Fingert@bmc.org.
Insights
Patient Navigation (PN) helps reduce disparities in autism spectrum disorder (ASD) services for vulnerable children. This study shows PN improves access to evidence-based care, informing future dissemination strategies.
Area of Science:
- Child Health Services Research
- Autism Spectrum Disorder Services
- Healthcare Disparities
Background:
- Significant racial, ethnic, and socioeconomic disparities affect access to evidence-based autism spectrum disorder (ASD) services for children.
- Patient Navigation (PN) is a care management strategy designed to mitigate these access disparities.
- Vulnerable children with ASD face barriers to timely diagnosis and treatment.
Purpose of the Study:
- To test the effectiveness of Patient Navigation (PN) in reducing disparities in access to evidence-based ASD services.
- To explore factors influencing the implementation of PN for children with ASD.
- To improve timely access to diagnosis and services for young children screened for ASD.
Main Methods:
- Hybrid type I randomized effectiveness-implementation trial with 125 participants per arm.
- Two-arm comparative effectiveness trial comparing PN to Conventional Care Management.
- Participants: families of children aged 15-27 months with positive ASD screen in urban primary care clinics across three states.
Main Results:
- The study aims to measure the diagnostic interval and time to receipt of evidence-based ASD services.
- Comparing PN to Conventional Care Management will determine effectiveness in reducing delays.
- A concurrent mixed-method implementation evaluation will assess factors affecting PN adoption.
Conclusions:
- Findings will indicate if PN is effective in improving access to evidence-based care for children with ASD.
- The study will inform future strategies for disseminating PN interventions.
- Effective implementation of PN can reduce disparities in ASD care access.
Background:
Significant racial, ethnic, and socioeconomic disparities exist in access to evidence-based treatment services for children with autism spectrum disorder (ASD). Patient Navigation (PN) is a theory-based care management strategy designed to reduce disparities in access to care. The purpose of this study is to test the effectiveness of PN a strategy to reduce disparities in access to evidence-based services for vulnerable children with ASD, as well as to explore factors that impact implementation.
Methods:
This study uses a hybrid type I randomized effectiveness/implementation design to test effectiveness and collect data on implementation concurrently. It is a two-arm comparative effectiveness trial with a target of 125 participants per arm. Participants are families of children age 15-27 months who receive a positive screen for ASD at a primary care visit at urban clinics in Massachusetts (n = 6 clinics), Connecticut (n = 1), and Pennsylvania (n = 2). The trial measures diagnostic interval (number of days from positive screen to diagnostic determination) and time to receipt of evidence-based ASD services/recommended services (number of days from date of diagnosis to receipt of services) in those with PN compared to and activated control -Conventional Care Management - which is similar to care management received in a high quality medical home. At the same time, a mixed-method implementation evaluation is being carried out.
Discussion:
This study will examine the effectiveness of PN to reduce the time to and receipt of evidence-based services for vulnerable children with ASD, as well as factors that influence implementation. Findings will tell us both if PN is an effective approach for improving access to evidence-based care for children with ASD, and inform future strategies for dissemination.
Trial Registration:
NCT02359084 Registered February 1, 2015.
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