ER NAVIGATOR Community Outreach for Personal Empowerment

ER Navigator Pilot Program Purpose: to connect self pay patients who are accessing the ER for primary care, with a community provider that they will then continue to access and value as their medical home

Process Navigators are trained as Certified Community Health workers The program works collaboratively with Harris County Hospital District/Gateway to Care’s Navigator Program ER staff and navigator communicate jointly to patients regarding the benefits to be derived in obtaining timely, continuity community care Navigator makes referral and continues to follow-up with patients by phone until one of the following occurs: –Patients are happy with the referral and understand the continued use –Patients ask not to be contacted –Patients are unreachable (after 3 follow-up attempts)

Effective communication from Physicians and nurses is essential to the process Do you have a medical home – a doctor or clinic where you get routine care and can call for any reason? If yes, reinforce need to use that source (tie that reinforcement to their clinical condition) If no, “you know it is really important for your health that you get routine care. Not only will that physician deal with your ________ that brought you here today, but conditions like blood pressure, blood sugar or cholesterol that can really impact your health will be dealt with as well.” I’m going to connect you to our Navigator who will help you find a medical home that is affordable. I really want you to make an appointment and start getting routine care. Personalize it. “I don’t want to see you in here with a stroke because you didn’t get that blood pressure controlled.”

Activity to Date Navigator began 1/2/2008 Hours are 11:30-8:00, M-F 384 unduplicated patients counseled 1097 contacts—2.9 per patient (follow up contacts made by phone on weekends) Primary referrals: –Echos, Christus, IBN SINA, Neighborhood Health Center, Hope Community Health Center

Challenges Consistency of ER referrals Placement of Navigator within the ER (more effective to have the program associated with the clinical process versus the financial process) Difficulty reaching patients for desired follow-up

Next Steps Outcome process: –A random sample of people will be contacted 6 months following service and asked the following to determine program effectiveness: What is the health home for yourself? What is the health home for other family members? How many times have you visited the ER since you received Navigation Services? With adequate outcomes, additional navigators will be strategically added within Memorial Hermann emergency rooms

The connections….. 1/2/08 Mr. Salinas came to the SW/ER for seizure. Navigator referred him to Christus Clinic and to ECHOS (for Gold Card). 1/24/08 Navigator called Patient for follow-up on referrals given. Patient’s wife reported that they had been to ECHOS and were helped greatly. She stated that going to ECHOS was like a big door that had been opened for them. Wife stated that Patient was able to be seen at Martin Luther King Health Center and Patient will be treated there. 3/11/08 Navigator called Patient for follow-up on health’s status. Patient’s wife stated that Patient is being treated at MLK and has an appointment to go to Ben Taub for an MRI. Patient’s wife stated that he is doing great, but the MRI is to make sure that nothing else is wrong. Patient’s wife is very pleased to have been to ECHOS. They helped them with a temporary Gold Card and soon they will apply for a Gold Card that will be good for a year. Through ECHOS they also got an appointment to go to the University of Texas-Vision Branch. She said that she is going to become a volunteer at ECHOS.

The connections….. 2/29/08 Ms. Butler came to the SW/ER with abdominal pain. Patient referred to IBN SINA Clinic and to ECHOS (for gold card). 3/10/08 Navigator called Patient for follow-up on referrals given. Patient stated that she was pregnant and would be receiving Medicaid benefits and would see a Medicaid doctor. Navigator closed the cased since Patient had a plan. 3/13/08 Navigator received a call from the Patient. She stated she needed a referral to go to a doctor in the interim of waiting for Medicaid. Navigator referred her to HOPE Community Health Center. 3/24/08 Navigator called Patient for follow-up on referral. She had been to the HOPE Clinic. She also now has Medicaid. The Patient stated that she would keep the HOPE Clinic reference for future needs.