12 Focus_Group_Health_Provider

Patient Navigator Demonstration Program

(PNDP)

SITE VISIT DISCUSSION GUIDE

Health Care Providers

March 23, 2011

Semi-Structured Discussion Guide:
Health Care Providers

This section describes questions and probes associated with semi-structured discussions with health care providers interacting with PNDP navigators. NOVA will meet with health care providers for whatever time is available, no more than 15 minutes with each.

A. Welcome and Introduction

Hello, I’m [name]. I am working to understand how best to implement navigator projects in sites across the country. The purpose of this discussion is to obtain information on planning and implementation of the navigator project at [Grantee Organization]. Your experience with implementation will provide insights for current and future HRSA projects.

How does the Patient Navigator work with you in your role as a health care provider?

Do you know which of your patients are involved in navigation services? How do you know this?

Listen for: Through EMR, email announcement on intra-office network, patient report, other

Do you send patients to PNDP? If yes, for what services? What has that experience been like for you?

Probe How easy or hard is it to get a navigator to meet with your patient? What are you hoping to accomplish when you send a patient to be navigated?

Listen for: Disease Management services, psychosocial support, logistical support, assist with provider-patient communication, other.

Probe Did you become aware of a specific issue with the patient, or did you identify the patient for navigation through established criteria?

If you do not send patients to navigators, what would make it more likely for you to do so?

Probe Are there specific benefits that might motivate you to recommend navigation? Is there any change in procedures that would streamline the process? What gets in the way?

Do navigators “send” patients to you? How does that work?

Probe Would you know if a navigator has sent a patient to you? [If yes:] Did you think the action was appropriate, or not appropriate? Tell me about that.

Probe Possible Related Questions: Has a navigator ever accompanied a patient to an appointment with you? What was that like? Did you feel the navigator’s presence was more of a help or a hindrance?

Probe Has a navigator ever provided information concerning a patient to you? How was the information conveyed?

Probe Do you receive as much feedback from patient navigators as you’d like? Would you prefer more or less communication from PNDP?

Probe For example, did the PN drop by your office, enter a notation through EMR, phone you or your office, communicate with your staff, was this a hallway conversation, or within a case review environment?

How do navigators communicate with you about patient care? What mode of communication would you prefer?

Probe ……For example, did the navigator tell you about a patient’s family or personal situation?

Informed provider about patient’s culture or beliefs, clarified a misunderstanding, informed about a patient’s attitude, informed about a patient’s adherence or non-adherence to a provider recommendation, patient’s attendance at another provider’s office, e.g., ER visit/hospital admission.

How would you characterize the role of navigators at [navigator organization]?

Probe To what extent are navigators viewed as an integral part of the health care delivery team? Is it appropriate to have navigators participate in case reviews, or is it not?

B. Assessment

How helpful have the navigators been to your practice?

Probe In what ways? Have you heard anything about PNDP from your patients or from your staff? What have you heard? What are examples of where PNDP has been successful? Are there examples you can think of where it did not work as well?

How do you think the project is doing? Why?

What is the impact of the navigator project on patient care?

Probe Have patient navigators improved patients’ keeping appointments? How do you know this? Is this tracked in any way?

Probe Have patient navigators improved patient treatment adherence? How do you know this? Is this tracked in any way?

Probe Have navigators improved adherence to your recommendations or helped a client to access services? How do you know this? Is this tracked in any way?

Probe Have patient navigators helped to “fill in the gap” in continuity of care, e.g., provide report of patient specialist visit? How important is this factor to your practice?

Have navigators improved health outcomes for any of your patients?

Probe How do you know this? Is this tracked in any way?

C. Strengths and Challenges

From your perspective, what are the major strengths of the project? What do you think that navigators do well?

From your perspective, what are the major challenges that face PNDP?

Probe How are they being met, or are they not? Does having this project in place create unintended consequences for you or your unit? Have these been addressed with either the navigator or the PNDP administrative staff? Do you have any ideas about how those challenges could be met more effectively?

D. Lessons Learned

Now that you have had experience with PNDP, are there any key lessons you would like to convey?

Probe Would you recommend that other health care organizations implement such a project? What advice would you give the providers? [For example, advice on mode of encounter with navigator; nature of relationship between navigators, physicians and other health care staff?] What advice would you give to the organization? What advice would you give to the navigation staff?

E. Wrap Up and Closing

We’re coming to the end of the discussion. Is there anything else you think I should know about the Patient Navigator project?

Thank you so much for your time. It has been interesting and enlightening.