Improvements in the quality of US health care have not equally benefitted low income and minority children, who remain more likely than other children to have worse health care experiences and outcomes across the spectrum of clinical settings and diseases. Patient navigator programs, in which lay health workers help patients navigate the system, have shown promise for improving quality of care among specific patient populations, but are not widely implemented due to cost and disease-specific content. A less costly, more broadly applicable program would have the potential to improve quality and outcomes for a larger population of low income minority children. The long-term objective of the K23 candidate, Casey Lion, MD, MPH, is to improve health care quality, experiences and outcomes for underserved children by developing and evaluating systems-oriented, family- engaged interventions with potential for broad population impact. This goal is consistent with the US Department of Health and Human Services Healthy People 2020 overarching goal to achieve health equity, eliminate disparities, and improve health for all groups. To achieve her objective, Dr. Lion will undertake didactic and experiential training to improve knowledge and skills in four areas: (1) patient navigation;(2) participant-engaged program development and research;(3) behavioral interventions;and (4) dissemination and implementation science. Dr. Lion has assembled a mentorship team with expertise in health care quality research, disparities, patient navigation, economic evaluation, and participant-engaged research, to ensure completion of the proposed research and training and successful transition to independence. Dr. Lion proposes three sequential, innovative projects that build upon her training goals. These projects will contribute to the development and pilot evaluation of an inpatient navigation program for families of low income, minority children, targeted to the family skills, knowledge and attitudes that are most likely to improve outcomes and are common across diagnoses.
The specific aims are: (1) to determine the relative importance of family skills, attitudes and behaviors that navigation might target as mediators of the relationship between demographic characteristics and outcomes for hospitalized children;(2) to collaborate with key stakeholders to develop a targeted inpatient navigation (TNav) program, focused on the mediators identified in Aim 1;and (3) to pilot test the feasibility, acceptability, cost and potenial impact of the TNav program for families of low income, minority hospitalized children. Outcomes will include health-related quality of life, in- hospital pain control, length of stay, hospital cots, and 30-day readmissions. This proposal is novel in its expansion of patient navigation to a more inclusive population;in its adaptation of navigation into a briefer, less costly intervention to facilitate dissemination;and in its consideration of low income, minority hospitalized children, a group for which few interventions have been shown to improve outcomes.

Public Health Relevance

Improvements in the quality of US health care have not equally benefitted low income and minority children, who continue to receive lower quality health care and have worse outcomes than other children. Eliminating health care disparities has been identified by governmental and academic bodies as a national priority. The overall goal of this proposal is to improve hospital outcomes, experiences, and quality of care for low income and minority children by developing a targeted inpatient navigation program with potential for broad dissemination and population impact.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Developmental Biology Subcommittee (CHHD)
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Haverkos, Lynne
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Seattle Children's Hospital
United States
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Lion, K Casey; Kieran, Kathleen; Desai, Arti et al. (2018) Audio-Recorded Discharge Instructions for Limited English Proficient Parents: A Pilot Study. Jt Comm J Qual Patient Saf :
Lion, K Casey (2017) Caring for Children and Families With Limited English Proficiency: Current Challenges and an Agenda for the Future. Hosp Pediatr 7:59-61
Lion, K Casey; Wright, Davene R; Desai, Arti D et al. (2017) Costs of Care for Hospitalized Children Associated With Preferred Language and Insurance Type. Hosp Pediatr 7:70-78
Lion, K Casey; Wright, Davene R; Spencer, Suzanne et al. (2016) Standardized Clinical Pathways for Hospitalized Children and Outcomes. Pediatrics 137:
Lion, K Casey; Ebel, Beth E; Rafton, Sarah et al. (2015) Evaluation of a quality improvement intervention to increase use of telephonic interpretation. Pediatrics 135:e709-16
Lion, K Casey; Raphael, Jean L (2015) Partnering health disparities research with quality improvement science in pediatrics. Pediatrics 135:354-61
Lion, K Casey; Brown, Julie C; Ebel, Beth E et al. (2015) Effect of Telephone vs Video Interpretation on Parent Comprehension, Communication, and Utilization in the Pediatric Emergency Department: A Randomized Clinical Trial. JAMA Pediatr 169:1117-25