Investigating patient navigator impact on older adults’ transitions from acute care: A randomized controlled trial with embedded qualitative component

TL;DR

This study examines how patient navigators affect older adults transitioning from hospital care after fractures, finding mixed impacts on healthcare use and patient experiences.

Contribution

The study introduces a mixed-methods approach to evaluate patient navigators in orthogeriatric care, combining quantitative and qualitative insights.

Findings

Patient navigators reduced unplanned healthcare use at lower frailty levels but increased it as frailty worsened.

Patients and caregivers reported positive experiences with patient navigators, especially regarding information and support.

Patient satisfaction did not differ significantly between groups.

Abstract

Fall-related injuries such as fractures are on the rise among older adults. Resulting transitions in care from hospital can be complex and place significant pressure on healthcare teams. This study sought to determine the impact of patient navigators in the orthogeriatric context.

A concurrent embedded mixed methods design was used, in which the quantitative, open label, randomized controlled trial, analysed using structural equation modelling, had an embedded reflexive thematic analysis qualitative component. Older adults (≥65 years) admitted to an orthopedic unit with any fracture were randomized into the standard of care or patient navigator group and followed until three months post-discharge. Main outcomes were, unplanned healthcare utilization post-discharge, patient satisfaction, and patient/caregiver experiences. Semi-structured interviews were conducted with patients (n = 60) and caregivers (n = 15) in both groups.

The patient navigator group (n = 34) had fewer unplanned healthcare utilizations post-discharge at lower levels of frailty and more unplanned healthcare utilizations post-discharge as frailty increased compared to the standard of care group (n = 36). Patient satisfaction was not significantly different between groups. Comparisons between the standard of care and patient navigator patient and caregiver groups found the patient navigator groups had unique themes, detailing the positive impact of the patient navigator, particularly in relation to the provision of information and support.

Patient navigators play an important role in orthogeriatric rehabilitation by facilitating more appropriate use of healthcare resources. Patients and caregivers found patient navigators supportive and helpful with care. Patient navigators were shown particularly helpful for participants with higher care needs and would also be beneficial for patients with fewer family supports. Trial Registration: NCT06107699

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