eval matrix

HRSA Patient Navigator Demonstration Program Framework

Evaluation Questions
1. Who is the target population of
navigation?

2. What are the socio-demographic
characteristics of navigated
patients?
Do they match the demographics of
the target population?

3. What is the incidence and
prevalence of diseases (covered by
Grantees) in target population
(catchment area population)?
4. What conditions are targeted by
the patient navigation program?

5. What barriers to quality health
care are experienced by navigated
patients?

Information Required

Baseline Indicators/
Benchmarks










Age
Gender
Race
Ethnicity
Primary language
Education
Income (mean, median)
Insurance
Patient-level:


















Age
Gender
Ethnicity Race
Primary language
Education level
HH Income
HH size
Insurance
Pharmacy Assistance
Disease types
Disease incidence
Disease prevalence
Disease screening rates in
catchment area
Diseases or condition type(s)
Abnormal screens
Disease stage
Point of entry (Point along care
continuum where patient is
navigated)

Structural Barriers (patient) & System
Barriers:





60% navigated patients are
from target population

Data Sources

Data
Collection
Methods

Site-specific to
each grantee.
The grantee
decides their
audience and
data sources.

Site Specific

Descriptive
statistics

Patient intake
form

Patient intake
form

Descriptive
statistics

Site Specific

Descriptive
statistics

Medical record
review by PN

Descriptive
statistics

Patient intake
form

Descriptive
statistics

Site specific –
the site
determines this
based on need
Medical
records
reviewed by
site
Patient intake
form

Transportation
Housing
Social/Practical Support
Language/Interpreter

NOVA Research Company, 12/22/08

Data
Analysis
Methods

Page 1 of 4

HRSA Patient Navigator Demonstration Program Framework
Evaluation Questions

Information Required

Baseline Indicators/
Benchmarks

Data Sources

Data
Collection
Methods

Data
Analysis
Methods







Literacy
Childcare Issues
Adult Care
Location of Health Care Facility
Insurance, uninsured,
underinsured, high co-pays

Financial problems

Employment Issues

Communication concerns with
medical personnel

Fear

Medical and mental health
comorbidity

Patient disability

Out of town/country

Perceptions/beliefs about
tests/treatment

System problems with scheduling
care

Attitudes towards providers No
Barrier Identified

System proactive navigation
needed

Other
Community barriers

6. What are socio-demographic of
PNs?







Age
Gender
Race
Ethnicity
Education

7. How are PNs recruited?




PN job postings/advertisements
# PN applicant interviews

8. What are work characteristics
and qualifications of hired PNs?




# PNs hired
Type (lay/professional)

NOVA Research Company, 12/22/08

PN

PN

Descriptive
statistics

Quarterly
Report
100% PN jobs are filled by
end of Year 1

Grantee
director/coordi

Quarterly
Report

Page 2 of 4

Descriptive
statistics

HRSA Patient Navigator Demonstration Program Framework
Evaluation Questions
(Report – p.5: PN requirements

9. How are PNs assigned?
(RFA p.40)
What to put in front of grantees?

10. What were the learning
objectives of PN training
program(s)?
Did PN trainees achieve learning
objectives?

Information Required











Training (including PN or CHW
certification)
Prior work experience
Languages spoken
PN Job Descriptions
# patients navigated
PN caseload (# patients per PN)
PN skill match for each of 6 duties
(e.g., some PNs do outreach,
others coordinate care)
Demographic coverage area
Training plan (incl. minimum
requirement; objectives,
description, timeline, culturally
competent content, methods)



Competency/ Performance incl.
client interaction; care
management; PN interventions,
documentation.



Certifications if/when applicable

11. What interventions do PNs use
to eliminate/reduce patient barriers?



Enrollment date of navigated
patients

Link to the six duties?



PN activities addressing barriers



Individual structural barriers



Individual educational/ emotional
barriers



System Barriers



Community barriers



Other PN activities/services
provided



# patients referred & type referral
(treatment, pharma assistance
programs, ombudsman programs/
other insurance programs,

NOVA Research Company, 12/22/08

Baseline Indicators/
Benchmarks

Data Sources

Data
Collection
Methods

Data
Analysis
Methods

nator
PN
Quarterly
Report
Workshop
Grantee
Application
100% PNs w/ increased post
test score
75% PNs demonstrate
competency at 3mo; 90%
demonstrate competency at
12 mo

PNs
PN trainers &
supervisors

Quarterly
Report/Training
Plan

Descriptive
statistics,
Chi square

PN Tracking
Log incl.
barriers,
activities to
address
barriers, and
related patient
outcome

Descriptive
statistics

Training
Plan/curriculu
m

PN
Patient intake
form

Patient intake
form

Page 3 of 4

HRSA Patient Navigator Demonstration Program Framework
Evaluation Questions

Baseline Indicators/
Benchmarks

Information Required

Data Sources

Data
Collection
Methods

Data
Analysis
Methods

community orgs, clinical trials)

12. What are outcomes of PN
interventions and services in
eliminating/reducing barriers faced
by navigated patients?



Intensity of intervention



PN activity outcome (e.g., #
uninsured who get coverage; #
patients where clinical trials
discussed)
Patient compliance rate for health
care appointments (missed
appointments)
Patient compliance with follow-up
exams/tests
#, type, and audience for outreach
activities
Loss to PN followup
Loss to chronic disease followup
Number community orgs receiving
referral for services to navigated
patients
Number patients participating in
clinical trials
Decreased ER/hospital utilization
rates for condition being navigated
Increased knowledge(utilization) of
clinical trials
Increased use of behaviors to
prevent or mitigate chronic disease
Time interval b/t dx or referral &
resolution date














13. Does reduction of barriers lead
to more timely access to quality
health care for navigated patients?



NOVA Research Company, 12/22/08



75% patients receive
early prevention or
screening service (PN
duty #1)
75% patients received
prompt diagnostic and
treatment resolution (PN
duty #4)
75% patients notified of
available clinical trials
(PN duty #3)
8% eligible patients
participate in clinical
trials (PN duty #3
75% patients do not miss
appointment
75% patients have
scheduled exams/tests
75% patients obtained
health care coverage
(insurance)

PN



75% patients receive
diagnosis w/in 60 days of
abnormal screen

Clinic/hospital
records



75% patients begin
treatment after diagnosis
w/in 30 days











Patient intake
form
Clinic/hospital
records

PN Tracking
Log incl.
barriers,
activities to
address
barriers, and
related patient
outcome

Descriptive
statistics

Medical
records/ clinic
records.
Billing records,
encounter
records.

Medical record
abstraction

Page 4 of 4

Descriptive
statistics