Community navigators reduce hospital utilization in super-utilizers.

OBJECTIVES: Super-utilizers place a significant burden on the healthcare system. Blending the roles of patient navigators and community health workers may address the clinical and social needs of these patients. This study evaluated the effectiveness of community navigators in reducing hospital utilization and costs among super-utilizers from a low-income area in Memphis, Tennessee. STUDY DESIGN: Controlled pre-post (difference-in-differences [DID]) design using Methodist Le Bonheur Healthcare electronic health records from 2013 to 2016. METHODS: Data were abstracted for 1 year pre- and post intervention for super-utilizers working with a community navigator (n = 159) and a control group of similar super-utilizers (n = 280). We compared utilization (hospital encounters, total hospital days, days between encounters, 30-day readmissions) and costs before and after working with a navigator for the intervention group with utilization and costs in a control group not working with a navigator and compared relative changes using a DID approach. RESULTS: Utilization and cost outcomes for intervention and control groups declined significantly from the pre- to postintervention periods. Relative to the control group, super-utilizers working with community navigators had an additional 13% reduction in hospital encounters (95% CI, -19% to -6%), 8% reduction in total hospital days (95% CI, -14% to -2%), and 9% increase in days between encounters (95% CI, 4%-15%). The intervention group also had additional reductions in 30-day readmissions (-18%; 95% CI, -44% to 22%) and costs (-$4903; 95% CI, -$13,579 to $3774), but these were not statistically significant. CONCLUSIONS: Community navigators can reduce subsequent hospital utilization in super-utilizers. Expansions of this model should examine the model's effectiveness in other populations and outcomes.

Too Much or Too Little? How Much Control Should Patients Have Over EHR Data?

Electronic health records (EHRs) have been promoted as a mechanism to overcome the fragmented healthcare system in the United States. The challenge that is being discussed is the rights of the patient to control the access to their EHRs' data and the needs of healthcare professionals to know health data to make the best treatment decisions for their patients. The Federal Trade Commission has asked those who store consumer information to comply with the Fair Information Practice Principles. In the EHR context, these principles give the rights to the patient to control who can see their health data and what components of the data are restricted from view. Control is not limited to patients, as it also includes parents of adolescent children. We suggest that the ongoing policy discussion include consideration of the precise questions patients will be asked when a need for data sharing arises. Further, patients should understand the relative risks that they face, and the degree to which their decisions will (or will not) significantly reduce the risk of a data breach. As various approaches are considered, it is important to address the relative resource requirements and the associated costs of each option.