The Community Health Navigator (CHN) program was created as part of ENhancing COMmunity health through Patient navigation, Advocacy, and Social Support (ENCOMPASS), a research collaboration between the University of Calgary (UofC), University of Alberta (UofA), and several Alberta Primary Care Networks (PCNs). This study assessed the impact of patient navigation by CHNs for people with chronic health conditions.
A systematic review was conducted in order to develop a program theory for patient navigator programs. This preliminary theory was later refined using feedback from patients and providers, and data from a feasibility study at Mosaic PCN in 2016. This resulted in an updated program theory that informs how the CHN program is being delivered today. The program theory, in its present form, is shown below and describes CHN activities, mechanisms of action, and anticipated outcomes.
Initial findings from the feasibility study and the development of a program theory informed a large cluster-randomized trial at Mosaic PCN. PCN leadership met with the research team during co-design sessions to establish recruitment, training, sustaining, and evaluation procedures for the program. CHNs were hired and worked with individual patients for on average six months, delivering supports tailored to patients’ needs and health priorities.
In 2019, the ENCOMPASS trials expanded to Calgary West Central, Edmonton O-day’min, and West View PCNs in order understand if the program can be feasibly scaled and spread to PCNs across Alberta. The program was designed to adapt to individual PCNs’ needs, integrating CHNs into either co-located medical home teams or centralized interdisciplinary care teams. The study employed the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to examine the scalability of the community health navigation program. The trials at Mosaic PCN and the expansion PCNs have concluded, and data analysis is currently underway.
Three ENCOMPASS partner PCNs (Mosaic, Edmonton O-day’min, and West View PCN) have carried on delivering the program post-study, and Edmonton West PCN has successfully implemented the program. There are currently 20 CHNs supporting patients across Alberta. The CHN Community of Practice was formed, where CHNs meet periodically to learn, collaborate, and share experiences.
U of C researchers have carried on evaluating the spread and scale of the CHN program as part of a new research opportunity under the Primary Care Innovation Fund. They are actively looking to partner with five PCNs who would like to see how the CHN program functions at their PCN.