The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials

Abstract

Objective: To determine the effects of patient navigation (PN) on healthcare utilization outcomes using meta-analysis and the quality of evidence.

Methods: Medical and social science databases were searched for randomized controlled trials published in English between 1989 and May 2015. The review process was guided by PRISMA. Included studies were assessed for quality using the Downs and Black tool. Data were extracted to assess the effect of navigation on: health screening rates, diagnostic resolution, cancer care follow-up treatment adherence, and attendance of care events. Random-effects models were used to compute risk ratios and I² statistics determined the impact of heterogeneity.

Results: Of 3985 articles screened, 25 articles met inclusion criteria. Compared to usual care, patients who received PN were significantly more likely to access health screening (OR 2.48, 95% CI, 1.93-3.18, P<0.00001) and attend a recommended care event (OR 2.55, 95% CI, 1.27-5.10, P<0.01). PN was favoured to increase adherence to cancer care follow-up treatment and obtain diagnoses. Most studies involved trained lay navigators (n=12) compared to health professionals (n=9).

Conclusion: PN is effective to increase screening rates and complete care events.

Practice implications: PN is an effective intervention for use in healthcare.

Keywords: Cancer care; Healthcare utilization outcomes; Meta-analysis; Patient navigation.