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. 2025 Apr 1;179(4):375-382.
doi: 10.1001/jamapediatrics.2024.6192.

Effectiveness of Patient Navigation During Transition to Adult Care: A Randomized Clinical Trial

Susan Samuel  1   2   3 , Zoya Punjwani  1   2 , Daniella San Martin-Feeney  4 , Brooke Allemang  5   6 , Gregory M T Guilcher  7 , Eddy Lang  8 , Danièle Pacaud  1   3 , Jorge Pinzon  1   3 , Gail Andrew  4 , Lonnie Zwaigenbaum  4 , Curtis Perrott  9 , John Andersen  4   9 , Lorraine Hamiwka  1   3 , Alberto Nettel-Aguirre  10 , Scott Klarenbach  11 , Kerry McBrien  2   12 , Shannon D Scott  13 , Megan Patton  1 , Sophie Samborn  1 , Ken Pfister  1 , Laurel Ryan  1 , Gina Dimitropoulos  3   5   14 , Andrew S Mackie  4   15
Affiliations

Effectiveness of Patient Navigation During Transition to Adult Care: A Randomized Clinical Trial

Susan Samuel et al. JAMA Pediatr. .

Abstract

Importance: Transition to adult care is a challenging and complex process for youth and emerging adults with chronic health and/or mental health conditions. Patient navigation has been proposed to improve care during transition, but previous studies have used single disease cohorts with a nonrandomized design.

Objective: To compare the effectiveness of a patient navigator service to reduce emergency department (ED) use among adolescents and emerging adults with chronic health and/or mental health conditions undergoing transition to adult-oriented health care.

Design, setting, and participants: This was a pragmatic, parallel-group, nonblinded randomized clinical trial design. Patients were followed up for a minimum 12 months and maximum 24 months after enrollment. The setting was the Canadian province of Alberta, with a population of 4.3 million inhabitants, having 3 tertiary care pediatric hospitals serving the entire population with universal health coverage. Participants included youth aged 16 to 21 years, followed up within a diverse array of chronic care clinics, expected to be transferred to adult care within 12 months, residing in Alberta, Canada.

Interventions: A 1:1 allocation to either access to a personalized navigator, an experienced social worker within the health services environment, or usual care, for up to 24 months after randomization.

Main outcomes and measures: All-cause ED visit rate while under observation.

Results: A total of 335 participants were randomized over a period of 45 months, 164 (49.0%) to the intervention arm and 171 (51.0%) to usual care. After 1 patient withdrew, 334 participants (usual care: mean [SD] age, 17.8 [0.7] years; 99 female [57.9%]; intervention: mean [SD] age, 17.7 [0.6] years; 81 male [49.7%]) were included in the final data analysis. Among the participants, 131 (39.2%) resided in a rural location, and 126 (37.7%) had a self-reported mental health comorbidity during baseline assessment. We observed significant effect modification in the relationship between intervention and ED visits based on mental health comorbidity. Among those with a self-reported mental health condition, ED visit rates were lower in those with access to the navigator, but the association was not significant (adjusted incidence rate ratio [IRR] 0.75; 95% CI, 0.47-1.19). Among those with no mental health comorbidity, the corresponding adjusted IRR was 1.45 (95% CI, 0.95-2.20).

Conclusions and relevance: In this randomized clinical trial, the navigator intervention was not associated with a significant reduction in ED visits among youth with chronic health conditions transitioning to adult care. The study did not accrue sufficient sample size to demonstrate a significant difference between groups should it exist.

Trial registration: ClinicalTrials.gov Identifier: NCT03342495.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mackie reported receiving grants from Canadian Institutes for Health Research, Alberta Health Services, and Alberta Children’s Hospital Research Institute outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Consolidated Standards of Reporting Trials Diagram Showing Flow of Participants in the Trial
aOne participant requested complete data withdrawal.
See this image and copyright information in PMC

References

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