P2.E087: Patient navigation resolves health-related social needs amongst pediatric emergency department patients: Results from a single-center, mixed-methods study

Background: High-frequency pediatric emergency department (PED) utilizers identify several health-related social needs (HRSNs), including food, transportation, and housing insecurities. Patient navigation (PN) may facilitate resolution of HRSNs. Our objectives were to determine the effect of PN on HSRN resolution and assess facilitators and barriers to HRSN resolution amongst high-frequency PED utilizers after completion of a one-year PN program.

Methods: This was an embedded mixed-methods study conducted among publicly insured local residents presenting to an urban tertiary-care PED. An electronic survey was distributed to screen for HRSNs. Patients also self-reported if they were high-frequency PED utilizers (> 2 PED visits in prior 12 months). The survey was offered in English and Spanish. Of high-frequency utilizers that reported HSRNs, 70% were randomized to receive PN. During PN, navigators maintained electronic notes about progress towards resolving HRSNs including food, transportation, and housing insecurities. Quantitative data were analyzed using standard descriptive statistics. Pairwise comparisons of HRSN burden prior to and following the intervention were completed. Qualitative results provided contextual insight about ability of PN to resolve HRSNs. Content analysis was used to review and code qualitative data. Codes were revised and clustered into categories, from which themes about barriers and facilitators of HRSN emerged.

Results: Of 906 patients surveyed, 584 (64.4%) identified as high-frequency PED utilizers. 344 (58.9%) reported at least 1 HRSN. 240 (70%) were randomized to receive PN and 173 (72.1%) accepted the intervention. Among high frequency PED utilizers, 234 (40.1%) reported food insecurity, 124 (21.2%) reported transportation insecurity, and 197 (33.7%) reported housing insecurity. PN was instituted for 116 (49.6%) with food insecurity, 62 (50.0%) with transportation insecurity, and 107 (54.3%) with housing insecurity. After PN, HRSN was resolved in 62 (53.4%; p< 0.01) patients with food insecurity, 37 (59.7%; p< 0.01) with transportation insecurity, and 43 (40.2%; p< 0.01) with housing insecurity. From narratives, we identified three facilitators and two barriers to PN (Table). Facilitators included 1) PN is a potent tool to mitigate patient HRSN; 2) Low uptake of governmental resources is a clear opportunity for intervention; 3) Accessible, tangible resources can decrease patient burden of HRSN. Barriers included 1) Persistent financial strain, despite governmental assistance contributes to ongoing HRSN burden and 2) Failure to resolve HRSNs through PN occurred because of patient attrition.

Conclusion: In high frequency PED utilizers, food insecurity was the most prevalent HRSN, followed by housing and transportation insecurity. PN demonstrated success in resolving all three HSRNs, with greatest effect on transportation insecurity. PN is a powerful tool to mitigate HRSNs and is most effective when bridging the gap between available resources and patient uptake. The success of PN is tempered by persistent financial hardship despite available resources, structural obstacles, and sustaining engagement with PN.