This is an application for a K01 award for Dr. Mark Fleming, a medical anthropologist at the University of California, Berkeley (UCB). Dr. Fleming is establishing himself as an investigator focused on health system interventions to address social determinants of health for vulnerable populations. For this K01 award, Dr. Fleming proposes a novel mixed-methods study of patient navigation (PN) for emergency department (ED) high utilizers. ED high utilizers typically have multiple chronic illnesses and significant unmet social and behavioral health needs. PN is a promising intervention for health systems to address this combination of medical, social and behavioral health needs for high utilizers, but its effectiveness is poorly understood. Dr. Fleming will conduct a mixed-methods evaluation of an ED PN program implemented at the University of California, San Francisco (UCSF). He will determine the effect of ED PN on subsequent medical, social services and behavioral health utilization using an existing composite database (Aim 1). This will be the first study to measure whether ED PN for high utilizers actually changes utilization of social and behavioral health services situated outside of the medical system (including housing services, income support, and mental health and substance use treatment). This will enable Dr. Fleming to test the hypothesis that linkage to and use of these services mediates the effect of ED PN on subsequent reductions of acute care utilization. Dr. Fleming then will conduct a qualitative study to identify the tasks and processes that constitute ?navigation? and explain how ED-based PN works to achieve its effects (Aim 2). Finally, Dr. Fleming will use stakeholder-engaged, design engineering methods to develop an evidence-based, optimized PN program for high utilizers (Aim 3) and will subsequently propose an R01 to implement and evaluate the optimized intervention. This K01 award will provide Dr. Fleming with the support and research experience necessary to build on his training in medical anthropology and develop a mixed-methods research program in health services. To achieve this goal, this award will provide targeted training the following areas: 1) quantitative methods for health services research, 2) implementation science, and 3) professional development to become an independent health services investigator. Dr. Fleming?s training plan includes formal coursework, individual tutorials from his multi-disciplinary mentorship team, and participation in health services research and evaluation groups. Dr. Fleming has assembled a mentoring team comprised of primary mentor, Dr. Steven Shortell, national leader in health systems research and Director of the joint UCB-UCSF health services training program (AHRQ-T32), Dr. Urmimala Sarkar, expert in implementation science and innovative design methods for health services interventions, Dr. Nancy Burke, expert in mixed methods research in health systems, Dr. Maria Raven, Medical Director of UCSF ED PN program and expert in emergency medicine health services research, and Dr. Laura Gottlieb, national leader in health system social needs interventions.
High utilizers of the emergency department have a very heavy burden of chronic illness, significant unmet social and behavioral health needs, and account for a large proportion of health care spending. Improving care and decreasing costs of this patient population is an urgent demand for health systems. This project will provide evidence about the effectiveness of patient navigation for emergency department high utilizers, and will result in an evidence-based, optimized model of patient navigation to disseminate and test in future research.
