Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (School Staff), Educational Material (Provider), Patient Navigation,

Intervention Description: The intervention in the study is described as a school-based outreach pilot program aimed at increasing access and participation in State-subsidized health insurance. The specific activities of the intervention include including State-subsidized insurance marketing material in the student registration packet and providing outreach material to develop sustainable strategies for identifying uninsured children and systematically incorporating child health outreach into routine school district operations

Intervention Results: The study's results indicate that the school-based outreach program was effective in identifying uninsured children and facilitating their enrollment in State-subsidized health insurance programs. The outreach efforts resulted in a significant response rate, with a notable number of children enrolled in the program as a result of the intervention. These findings suggest that incorporating health insurance outreach into routine school district operations can be a successful strategy for reaching uninsured children and increasing their access to State-subsidized health insurance

Conclusion: The conclusion of the study suggests that integrating the collection of health insurance status into routine school communication channels is an effective way to identify uninsured children who may be eligible for State subsidized benefits. The research, conducted in Van Buren County, MI, estimates that 70% of the 1,211 uninsured children are eligible for State subsidized health insurance. A survey distributed with free and reduced lunch applications and school registration identified 156 uninsured children, raising questions about the external validity of the research. The study proposes the extrapolation of results to the entire county or even the state, emphasizing the simplicity of the survey and the statewide management of the Free and Reduced Lunch Program. The approach, already successful in several states, could provide a sustainable and everyday method for effective outreach to identify uninsured children. Additionally, the study rejects Ho2, stating there is a statistical difference in the number of applications received from a school-based outreach program during the pilot period. The analysis of application data shows a positive relationship between time and the number of applications received, with a predicted increase of 5.6593 applications in each subsequent period. The model's strength is supported by a relatively strong R² of 77.58%. However, the study acknowledges that 23% of the error remains unexplained, possibly due to factors such as the pilot outreach intervention. The actual number of applications in May 2013 exceeded the predicted range, suggesting factors not accounted for in the model.

Study Design: The study is described as a cross-sectional pilot study designed to employ a school-based outreach effort utilizing existing school communications to identify children who are currently uninsured and may be eligible for State subsidized health insurance.

Setting: State of Michigan schools

Population of Focus: The target audience for the study includes K-12 students and their families, particularly those who are currently uninsured and may be eligible for State subsidized health insurance.

Sample Size: The study identifies 156 children as not having health insurance, representing more than 44% of the 358 children who are eligible for State subsidized health insurance in the participating school districts

Age Range: The age range of the children involved in the study is K-12, which typically includes children between the ages of 5 and 18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Patient Navigation, Midwifery,

Intervention Description: The intervention described in the article is the Early Care Model for initiation of perinatal care. This model is a midwifery-led, patient-centered approach designed to reduce barriers to early initiation of perinatal care for pregnant individuals. The key components of the intervention include: Timely access to care as soon as pregnancy is confirmed or suspected. One-hour telehealth visits for early pregnancy assessment and support. Comprehensive assessment of clinical and social needs during the initial prenatal visit. Tailored perinatal care recommendations and referrals based on individual health history and preferences. Promotion of midwifery care and education about all care options. Use of virtual language interpretation services for increased accessibility. Focus on antiracist and antibias approaches to provide equitable care , . These components collectively aim to provide early and comprehensive care to pregnant individuals, address systemic barriers to care engagement, and promote improved outcomes and decreased disparities in perinatal health

Intervention Results: Instead, it focuses on describing the key strengths and components of the Early Care Model for initiation of perinatal care, as well as the potential impact of the model on health equity and perinatal outcomes. The article emphasizes the importance of early access to prenatal care, the benefits of the model's approach to care initiation, and the strategies for overcoming barriers to implementation, such as billing and reimbursement challenges in the United States healthcare system

Conclusion: The conclusion drawn from the article on the Early Care Model for initiation of perinatal care highlights the potential of this model to significantly impact health equity in perinatal care. The model is seen as a promising approach to reducing disparities, improving outcomes, and increasing access to early and comprehensive perinatal care for pregnant individuals. However, the article also acknowledges the real barriers to implementation, particularly related to billing and reimbursement systems in the United States healthcare system. To address these barriers and make the Early Care Model more accessible and actionable, the article presents recommendations for stakeholders, including health plans, legislators, and regulators. These recommendations focus on adjusting reimbursement to reflect the benefits of the model, expanding Medicaid coverage for pregnant individuals, and advocating for policy changes to support the adoption of innovative care delivery models like the Early Care Model . Overall, the article underscores the importance of addressing systemic challenges in healthcare delivery to promote equitable care, improve perinatal outcomes, and enhance access to quality care for pregnant individuals.

Study Design: the article outlines the key components and strategies of the model, focusing on its innovative approach to providing early and comprehensive perinatal care to pregnant individuals. The model is presented as a new care delivery approach aimed at reducing barriers to early initiation of perinatal care and improving health outcomes for pregnant people and their fetuses

Setting: it does mention that the model was developed and implemented by Quilted Health, a healthcare organization based in Washington state . The model is designed to be adaptable to the needs of specific communities and care settings

Population of Focus: The target audience for the Early Care Model for initiation of perinatal care includes pregnant individuals seeking prenatal care services. The model is designed to reduce barriers to early initiation of perinatal care and improve outcomes for pregnant people and their fetuses 2. Additionally, stakeholders involved in the implementation of the model, such as health plans, legislators, regulators, and perinatal care providers, are also key audiences for the recommendations and strategies outlined in the article

Sample Size: The focus of the article is more on the model itself, its strategies, and the potential impact on health equity in perinatal care

Age Range: However, the model is designed to provide early access to prenatal care for pregnant individuals, which typically includes adults of reproductive age. The focus is on improving perinatal outcomes and reducing disparities in care for pregnant individuals, regardless of their specific age range

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Home Visit (caregiver), Educational Material (caregiver), Oral Health Product, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), Education/Training (caregiver)

Intervention Description: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.

Intervention Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.

Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.

Study Design: RCT

Setting: Jefferson County in Louisville, KY

Population of Focus: Children aged 4-15 years who currently or for 2 years prior had Medicaid insurance but have not had Medicaid dental claims filed for the previous 2 years

Data Source: Medicaid claims

Sample Size: Intervention (n=68) Control (n=68)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation (Assistance), Concurrent Infant/Mother Checkups

Intervention Description: The Mother-Infant dyad postpartum primary care program was part of Ohio Gestational Diabetes Postpartum Care Quality Improvement Collaborative, a multi-year initiative sponsored by the Ohio Departments of Health and Medicaid and administered by the Ohio Colleges of Medicine Government Resource Center. The Dyad program evaluation was conducted in the context of a quality improvement (QI) initiative aimed at increasing postpartum type 2 gestational diabetes (T2DM) screenings during the 4–12 week postpartum period and also increasing postpartum visit attendance with a prenatal provider. Women were eligible for the Dyad program if they lived in central Ohio and had a diagnosis of gestational diabetes mellitus (GDM) during the most recent pregnancy or condition suggesting previous undiagnosed GDM. Following delivery, Dyad program appointments occurred concurrent with the infant’s well-check visits and allowed mothers to access comprehensive postpartum care services including but not limited to postnatal screening for T2DM, health and wellness education, breastfeeding support, and referrals to specialty services if indicated. An on-site patient navigator contacted mothers by phone in advance of the visit to address barriers to care including transportation and childcare. Reminders were also sent via phone and electronic health record (EHR) patient portal to con- firm attendance. The Dyad program facilitated postpartum obstetrics to primary care hand off to improve longitudinal care engagement for disease management and prevention.

Intervention Results: Women who participated in the Dyad program were more likely to complete a postpartum visit and receive type 2 diabetes mellitus (T2DM) screenings than women who did not participate. In addition, fewer women who participated in the program experienced new T2DM diagnoses (17%) than those in the comparison group (29%), yet a greater proportion of Dyad program participants experienced new predia- betes diagnoses (12%, p<.001) than those in the com- parison group (6%, p<.001).

Conclusion: The Mother-Infant Dyad postpartum primary care program improved type 2 diabetes mellitus screenings and postpartum visit attendance. In addition, a greater proportion of Dyad program partici- pants experienced new prediabetes diagnoses that those in the comparison group. Our findings suggest that the dyad care model, in which women with GDM engage in postpartum primary care concurrent with well-child visits, can improve longitudinal postpartum care after a GDM diagnosis.

Study Design: Analysis of patient surveys, claims data, and administrative records

Setting: Midwestern academic medical center internal medicine and pediatrics primary care clinic

Population of Focus: Postpartum patients with a previous diagnosis of gestational diabetes mellitus

Sample Size: 75 mother-infant dyads

Age Range: Mean age 30.75

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Community-Based Group Education, Patient Navigation,

Intervention Description: In 2014, the University of Illinois Health and Health Sciences System initiated the Coordinated Healthcare for Complex Kids (CHECK) program. This comprehensive care coordination demonstration project aimed to provide services for children and young adults with chronic health conditions in Chicago insured by Medicaid. CHECK adopted a holistic approach, addressing social determinants of health, caregiver wellness, mental health, and chronic disease management. The program targeted individuals with diagnoses such as asthma, diabetes, sickle cell disease, seizure disorder, or prematurity, spanning from birth to age 25. Participants were enrolled in the traditional, fee-for-service state Medicaid program or a Medicaid managed care organization (MCO) in Illinois. CHECK offered various services, including care coordination by community health workers (CHWs), mental health services by professionals, and disease-specific health education. CHWs assessed individual and family needs, analyzing health care utilization patterns in the year before enrollment. The program operated from May 1, 2014, to April 30, 2017, with data collection conducted in May 2018, covering the 12 months before and after randomization. For further details, refer to Table 4: Intervention Descriptions in the Evidence Review.

Intervention Results: In this analysis of the Chicago-based CHECK program (a large care-coordination initiative for low-income children and youth with chronic health conditions), overall Medicaid expenditures and utilization decreased considerably during the first year of the CHECK program for both CHECK participants and the usual care group. Notably, expenditures did not increase among CHECK participants, which has been noted in other care coordination programs. The rate of inpatient and ED utilization decreased for both groups. The mean (SD) inpatient utilization before enrollment in CHECK was 63.0 (344.4) per 1000 PYs for the intervention group and 69.3 (370.9) per 1000 PYs for the usual care group, which decreased to 43.5 (297.2) per 1000 PYs and 47.8 (304.9) per 1000 PYs, respectively, after the intervention.

Conclusion: Medicaid expenditures and utilization patterns decreased similarly among participants who were enrolled in the CHECK program and those in the UC group. Among children and young adults with asthma and those considered medium and high risk, a comprehensive care coordination program indicated that it could decrease ED utilization.

Study Design: RCT

Setting: Community (Coordinated Healthcare for Complex Kids (CHECK) program; Illinois Medicaid)

Population of Focus: Children with chronic diseases

Sample Size: The study involved a total of 6,245 children and young adults, with 3,119 individuals in the control group and 3,126 individuals in the intervention group.

Age Range: The study included children younger than 1 year old and youth older than 18 years. The mean age of the participants was 11.3 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Nurse/Nurse Practitioner, PROFESSIONAL_CAREGIVER, Patient Navigation (Assistance), Care Coordination, STATE, Multicomponent Approach

Intervention Description: The Healthy Beginnings system of care in Atlanta, GA connects children and their families to health insurance and a medical home model of care to support children’s health and development. The main components are care management + education and parent engagement + collaborative partnerships. A registered nurse, known as the health navigator, supports parents and helps them learn how to work with health care professionals on behalf of their children; they also connect parents to the Center for Working Families to ensure that they receive public benefits for which they are eligible.

Intervention Results: Healthy Beginnings coordinated care approach has ensured that participating children and families have health insurance (97%) and receive regular immunizations (92%), ongoing health care from a primary care physician and dental health provider, and regular developmental screenings (98%) and follow-up care. Healthy Beginnings has dramatically increased children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Conclusion: By building upon the partnerships formed through the foundation’s community change effort, Healthy Beginnings has dramatically increased neighborhood children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Study Design: Program evaluation

Setting: Community (Community-based organizations in Atlanta, Georgia)

Population of Focus: Low-income young children and families

Data Source: Questionnaire data

Sample Size: 279 children

Age Range: 0-10 years

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Enrollment Assistance, Patient Navigation,

Intervention Description: Healthy Beginnings seeks to prevent or reduce health disparities through a community-based, coordinated care approach based in a high quality early learning center. Healthy Beginnings is a system of care that connects children and their families to health insurance and a medical home to support children’s continuing health and development. The system also ensures that children have immunizations, periodic developmental screenings, and follow-up care, with frequent check-ups and assessments where indicated. It also provides families with health education both individually and through monthly workshops for groups of parents. The Healthy Beginnings partners worked together to develop a system of care that supports high-quality preventive health care for all children enrolled at Educare Atlanta. The system is integrated with the work of teachers and other staff at Educare Atlanta, as well as local health care providers, and it ensures that there is an ongoing relationship between parent and physician. The Healthy Beginnings main components are care management, education and parent engagement, and collaborative partnership. Healthy Beginnings employs one registered nurse, known as a health navigator, who supports parents and helps them learn how to work with health care professionals on behalf of their children; the health navigator also coordinates regular visits to pediatricians and other health care providers and resources.

Intervention Results: Results suggest that the Healthy Beginnings System of Care has been effectively implemented and has exceeded expectations in terms of achieving the goals of the State of Georgia Governor's Office for Children and Families. Data indicated overwhelmingly positive satisfaction with the system of care: 74% of respondents strongly agreed that they were satisfied. Very few respondents (fewer than 6%) reported that they were neutral, and none strongly disagreed that they were satisfied. In terms of short-term outcomes for participating children, Healthy Beginnings exceeded all of its performance requirements from the Governor's Office for Children and Families in 2013. For example, more than 90% of the children had health insurance and were up-to-date in their immunizations. Nearly all children visited a medical home at least annually, and 98% were current with developmental screenings, according to the Ages and Stages Questionnaires. By building upon the partnerships formed through the foundation’s community change effort, Healthy Beginnings has dramatically increased neighborhood children’s access to health care and forms the basis for cost-effective approach that can be replicated in other communities.

Conclusion: The Annie E. Casey Foundation has been investing in multiple human capital and housing and public open spaces redevelopment strategies in the neighborhoods of Neighborhood Planning Unit V in Atlanta for more than a decade. Although the Healthy Beginnings System of Care is still in its early stages, the foundation has found the concurrent focus on community change and health to be highly compatible with its family strengthening strategies—and a critical contributor to the well-being of the community’s children and families.

Study Design: Systems of care framework

Setting: Community (Community-based organizations in Atlanta, Georgia)

Population of Focus: Low-income young children and families

Sample Size: 279 children

Age Range: 0-10 years

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, PATIENT_CONSUMER, Educational Material

Intervention Description: This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). Data collected from March 1, 2012, to November 5, 2016, included 6663 follow-up surveys from participants aged 21–74.

Intervention Results: Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. For women aged 40–74 years (N = 4942; mean age = 52 years), 58.4% reported a mammogram within 6 months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87–7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77–4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21–64 years (N = 6169; mean age = 46 years), 37.7% received a Papanicolaou (Pap) test within 6 months on average from initial contact.

Conclusion: In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66–3.91) and PN only (OR: 2.35, CI: 1.88–2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P < 0.0001) for both screenings. PN, solely or in combination with education, is an effective strategy to increase screening for breast and cervical cancer, beyond educational outreach efforts alone, among un-/underserved, racially/ethnically diverse women in rural and border Texas counties.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Navigation, Other Person-to-Person Education, Referrals

Intervention Description: We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services.

Intervention Results: Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers.

Conclusion: The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

Study Design: Quasi experimental cross sectional -pilot

Setting: University obstetric and gynecology clinics

Population of Focus: Pregnant women over 18, smoked and expressed interest in quitting

Data Source: Expired air carbon monoxide (EACO), self-report, standardized scales

Sample Size: 50

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation , Referrals, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services.

Intervention Results: Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers.

Conclusion: The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Outreach (School Staff), Patient Navigation,

Intervention Description: The New York City Department of Health and Mental Hygiene’s Office of Health Insurance Services has partnered with the department’s Early Intervention Program to implement a Service Integration Model to enroll CSHCN, aged 0 to 3, into public health insurance. This model is based on a combined approach of educational messaging to clients and individual counseling or assistance to facilitate enrollment and renewal of health insurance serving a hard-to-reach and vulnerable population. This model uses data from program databases and staff from children’s programs to proactively identify uninsured and underinsured children and facilitate their enrollment into public health insurance. The model has 3 key components allowing for comprehensive and continuous coverage for CSHCN: (1) integration of program messages within the Early Intervention Program (e.g., welcome letter to parents, brochure and poster for provider agencies), (2) data matching with child program data (Early Intervention data, Medicaid data, Census data), and (3) incorporation of program staff (Office of Health Insurance Services child benefit advisors) to work directly with parents (e.g., available in multiple languages and at convenient hours and locations). The model overcomes enrollment barriers by using consumer-friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance. A key strategy is to prevent gaps in coverage resulting when parents fail to renew their children’s coverage. Staff are strategically co-located at the offices of providers who serve children enrolled in the Early Intervention Program.

Intervention Results: Since 2008, more than 5,000 children in the Early Intervention Program have been successfully enrolled and coverage renewed in Medicaid through the Service Integration Model. In 2008, the study team found that children in the Early Intervention Program had a34% churning rate for Medicaid because of enrollment barriers and misconception of the Early Intervention Program as a replacement for Medicaid. By 2010, the churning rate for clients assisted through Office of Health Insurance Services was reduced from 34% to 8%. The Office of Health Insurance Services will modify the Service Integration Model to respond to New York State’s implementation of the Health Insurance Exchange required by the 2010 ACA. The model is replicable by other government agencies serving the uninsured and underinsured. Partnerships across government programs and agencies offer opportunities to enroll hard-to-reach populations into public health insurance.

Conclusion: Partnerships across government programs and agencies offer opportunities to enroll hard-to-reach populations into public health insurance. The model reflects how government programs can work together to improve rates of enrollment and retention in public health insurance. The key elements of integration of program messages, data matching, and staff involvement allow for the model to be tailored to the specific needs of other government programs.

Study Design: Program evaluation

Setting: Community (New York City Department of Health and Mental Hygiene’s Office of Health Insurance Services and the Early Intervention Program)

Population of Focus: Young children with special health care needs

Sample Size: 6,500 children in early intervention with a Medicaid number

Age Range: 0-3 years

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (Health Care Provider/Practice), Patient Navigation, Care Coordination,

Intervention Description: The CPM brings inpatient child psychiatry consultation-liaison elements, such as team-based rounds, to an outpatient setting. Child psychiatry and family support specialist (FSS) staff were available weekly in the pediatrics clinic." Involved collaboration between psychiatry and pediatric providers.

Intervention Results: Holding all else constant, children receiving the CPM intervention had four times higher odds of accessing psychiatric evaluations than children in the usual care control group (adjusted odds ratio [AOR]=4.16, p<.01). The odds of engagement (i.e., participation in follow-up appointments) were seven times greater for youths in the CPM than youths in the control group (AOR=7.54, p<.01).

Conclusion: These findings serve as preliminary evidence suggesting that the CPM for integrated pediatric care should be further studied to isolate potential causal effects on the odds that children and families will receive needed mental health treatment. Additional areas for future investigation include heterogeneity of effect among subpopulations and across delivery systems; effectiveness of substituting other child mental health clinicians into the child psychiatrist role (given workforce capacity) or coordinating with other resources, such as telephone-based child psychiatry consults; and the unique effects of the FSS role on CPM outcomes

Study Design: Quasi-experimental pre-post study with nonrandomized intervention and control groups

Setting: Urban, safety-net hospital system pediatric clinics

Population of Focus: Children and adolescents ages 4-19 referred for psychiatric evaluation

Sample Size: 228 participants

Age Range: Ages 4-19 years old

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Community-Based Group Education, Other Person-to-Person Education, Patient Navigation

Intervention Description: We conducted a cluster-randomized trial at 23 ethnic churches in the Baltimore, Maryland–Washington, DC, metropolitan area between 2010 and 2014. Trained CHWs enrolled 560 women. The intervention group received an individually tailored cancer-screening brochure followed by CHW-led health literacy training and monthly telephone counseling with navigation assistance. Study outcomes included receipt of an age-appropriate cancer screening test, health literacy, cancer knowledge, and perceptions about cancer screening at 6 months.

Intervention Results: The odds of having received a mammogram were 18.5 (95% confidence interval [CI] = 9.2, 37.4) times higher in the intervention than in the control group, adjusting for covariates. The odds of receiving a Papanicolaou test were 13.3 (95% CI = 7.9, 22.3) times higher; the odds of receiving both tests were 17.4 (95% CI = 7.5, 40.3) times higher. Intervention effects also included increases in health literacy and positive perceptions about cancer screening.

Conclusion: A health literacy–focused CHW intervention successfully promoted cancer-screening behaviors and related cognitive and attitudinal outcomes in Korean American women.

Setting: 23 ethnic churches in the Baltimore,MD-Washington, DC area

Population of Focus: Korean American women who had not had a pap test in 24 months and who could read and write Korean or English

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Patient Navigation (Assistance), Outreach (Provider), Enrollment Assistance

Intervention Description: Community Health Centers (CHCs) serving low-income populations are well-positioned to support patients navigating the complexities of the public health insurance application process and prevent lapses in coverage. Specialized staff, called enrollment assistants, can help to determine insurance eligibility and/or guide patients through application processes, including assistance with completing application forms, understanding requirements, and providing appropriate documentation.

Intervention Results: Enrollment assistants are valuable resources, and CHCs are effective at helping patients with public health insurance. The enrollment assistants helped families understand the process and avoid mistakes and delays while patients valued their advice and their pragmatic, hands-on application assistance.

Conclusion: Patients’ understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking submitted applications to ensure approval. Families trusted clinic staff with insurance enrollment support, and appreciated it. CHCs are effective at helping patients with public health insurance. Access to insurance expiration data, tools enabling enrollment activities, and compensation are needed to support enrollment services in CHCs.

Study Design: Observational cross-case comparison

Setting: Community (Community-health centers in Oregon)

Population of Focus: Practice members (e.g., managers, clinical and non-clinical staff, enrollment assistants) and families using community health centers

Data Source: Observations and interviews

Sample Size: 4 Community Health Centers (CHCs) in Oregon; 26 practice members; 18 adult family members who had at least one pediatric patient

Age Range: Parents and children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Community-Based Group Education, Patient Navigation

Intervention Description: Assess the effectiveness of a culturally customized program (Esperanza y Vida [Hope and Life]) in increasing breast and cervical cancer screening among Latinas, and to examine how screening rates related to changes in cancer knowledge, differences in ethnic origins, and geographic location.

Intervention Results: Screening rates were significantly higher for the intervention versus the control group for clinical breast examination (CBE; 48% vs. 31%; adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.1-4.2), breast self-examination (45% vs. 27%; aOR, 2.3; 95% CI, 1.1-5.0), and Pap testing (51% vs. 30%; aOR, 3.9; 95% CI, 1.1-14.1), but not for mammography (67% vs. 58%; aOR, 0.7; 95% CI, 0.1-3.6).

Conclusion: Esperanza y Vida has the potential to reduce health disparities in breast and cervical cancer morbidity and mortality rates through increasing cancer screening and thereby increasing early detection.

Study Design: Cluster RCT

Setting: Arkansas and New York City, NY

Population of Focus: Latina women

Data Source: Telephone survey

Sample Size: Baseline (n=487) Intervention (n=308); Control (n=179) Follow-up (n=238)

Age Range: Mean: 39.3

Intervention Components (click on component to see a list of all articles that use that intervention): Other Person-to-Person Education, Patient Navigation

Intervention Description: A qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews. Data were extracted and analysed thematically. Additionally, first-dose coverage rates were categorised as above 90 %, 90–70 %, and below 70 %, and cross-tabulated with mobilisation timing, message content, materials and methods of delivery, and consent procedures.

Intervention Results: All but one delivery experience achieved over 70 % first-dose coverage; 60 % achieved over 90 %. Key informants emphasized the benefits of starting social mobilisation early and actively addressing rumours as they emerged. Interactive communication with parents appeared to achieve higher first-dose coverage than non-interactive messaging. Written parental consent (i.e., opt-in), though frequently used, resulted in lower reported coverage than implied consent (i.e., opt-out). Protection against cervical cancer was the primary reason for vaccine acceptability, whereas fear of adverse effects, exposure to rumours, lack of project/programme awareness, and schoolgirl absenteeism were major reasons for non-vaccination.

Conclusion: Despite some challenges in obtaining parental consent and addressing rumours, experiences indicated effective social mobilisation and high HPV vaccine acceptability in LMICs. Social mobilisation, consent, and acceptability lessons were consistent across world regions and HPV vaccination projects/programmes. These can be used to guide HPV vaccination communication strategies without additional formative research.

Study Design: A qualitative study design

Setting: Not specified

Data Source: A qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews.

Sample Size: 1452 studies/ abstracts reviewed/ interviews

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation (Assistance), Patient Reminder/Invitation, Participation Incentives, Shortened Appointment Interval

Intervention Description: Women were randomized to receive 3–4 and 6–8 weeks postpartum appointments and were followed for 18 months. Study participants were recruited from the VCUMC in-patient postpartum unit by using Electronic Health Records (EHR) to monitor deliveries. Eligible women were contacted within 48 h of delivery and informed about the study. Women who agreed to participate were asked to sign the informed consent form, which authorized research staff to access participants' EHR to enhance tracking of postpartum visit attendance. Study participants were interviewed in person at baseline (within 48 h of delivery) and at the postpartum visit. Participants were compensated $25 for completing the baseline interviews and $30 for completing the postpartum interviews. Follow-up assessments were administered via telephone at 3, 6, 9, 12, and 18-months post-delivery to evaluate secondary outcomes including contraceptive use, infant feeding practices, pregnancy status, stress and social support, and socio-demographic and medical information. Each of the follow-up assessments lasted approximately 10–15 min, and participants were compensated $10 per follow-up assessment. To reduce loss to follow-up, participants' contact information, as well as contact information for at least three persons who would know the participants' whereabouts and could get messages to them, were collected from the patients. To compensate study subjects for their participation and encourage follow-up assessment compliance, thank you letters along with appointment reminders and additional $10 checks were mailed to each participant monthly. This was especially important for hard-to-track women who did not have working phone numbers and did not return for postpartum visits. Additionally, per study protocol, participants received appointment reminder SMS text messages and/or emails 1 day before their scheduled follow-up phone interviews. If participants could not be reached, up to four attempts were made to contact the participant on different days and times of the day, in an effort to schedule the interviews.

Intervention Results: The overall postpartum visit adherence rate was generally high in the study. However, the adherence rate was observed to be relatively lower in the 3–4 weeks group (71%) compared to the 6–8 weeks group (90%). One reason that may explain this finding is that participants may have been more familiar with the traditional 6–8 weeks postpartum visit and thus, may have had some inertia or difficulty in attending a 3–4 week postpartum visit. A large proportion of women were retained in the study as demonstrated by the high completion rates at the 18-month follow-up interview (Total sample: 87.6%; 3–4 weeks group: 88.0%; 6–8 weeks group: 87.3%). Similarly, high adherence to the protocol-directed postpartum visit schedule was reported in the overall study sample (79.7%), as well as in the 3–4 (70.5%) and 6–8 (90.0%) week postpartum groups.

Conclusion: In this trial, we successfully maintained high completion rates throughout the course of the study. This is important given that the study population included hard-to-track women who typically do not return for postpartum visits [12]. Due to economic challenges, underserved women may not have permanent addresses or phone numbers. By utilizing a participant tracking form, we obtained contact information from at least three persons who generally knew the participants' whereabouts and could contact them. This provided multiple avenues for reaching participants and enhanced retention. Additionally, monthly communication and incentives provided the opportunity to maintain participant engagement.

Study Design: Prospective, open-label randomized control trial

Setting: Virginia Commonwealth University Medical Center

Sample Size: 364 women

Age Range: 18-43

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Navigation

Intervention Description: Patient navigation is a patient-centered intervention that uses trained personnel to facilitate comprehensive and timely access to health services. Short-term assistance and health education are two facets of patient navigation; however, it seeks to sustainably eliminate health inequity by fostering the trust and skills patients need to stay engaged with care in the long term.

Intervention Results: Existing studies examining the efficacy of patient navigation interventions show particularly striking benefits in the realm of cancer care, including gynecological oncology; patient navigation has been demonstrated to increase access to screening, shorten time to diagnostic resolution, and improve cancer outcomes, particularly in health disparity populations. Because of the successes in cancer care at reducing disparities in health care access and health outcomes, patient navigation has the potential to improve care and reduce disparities in obstetric and benign gynecological care.

Conclusion: Because of the successes in cancer care at reducing disparities in health care access and health outcomes, patient navigation has the potential to improve care and reduce disparities in obstetric and benign gynecological care.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation,

Intervention Description: The intervention in the study involved the use of a patient navigator embedded at four federally qualified health centers (FQHCs) as part of a cluster randomized control trial (RCT) testing the effectiveness and implementation of a social needs screening and referral care model called WE CARE (Well-child care, Evaluation, Community resources, Advocacy, Referral, Education) in pediatric primary care,. The patient navigator's primary task was to connect parents with unmet social needs to community-based health and social services, and she worked both on-site and remotely, dividing her time between the FQHCs. The patient navigator received referrals from clinicians, followed up with patients, and assisted families with enrollment in social needs resources,. The study aimed to assess whether a patient navigator located on-site versus remotely is more likely to receive referrals from clinicians, successfully follow-up with patients, and assist families with enrollment in social needs resources.

Intervention Results: A total of 414 parents were referred to the patient navigator during the study period. Overall, the majority of parents were Black or African American (63.8%), not Hispanic or Latino (69.3%), English speaking (75%), and publicly insured (90.8%) (Table 1). The average age of referred patients was 1.7 years (SD, 4.6 years; range, 0-42 years of age). The most common unmet needs requiring assistance were childcare (42% of families), housing (29% of families), and utilities (21% of families) (Table 2).

Conclusion: Yes, the study found statistically significant differences in the number of referrals made to the patient navigator when the navigator was on-site versus remote. When the navigator was on-site, significantly more referrals were made than expected (45% vs 29%, P < .0001),. However, there were no significant differences between on-site and remote navigation in terms of successful contacts with families or enrollment of families in resources,. The study also found that the majority of clinician referrals were made through the EHR (83%) versus in person (16%) (P < .0001).

Study Design: The study design used in this research is a quantitative observational study. The researchers quantitatively assessed the impact of an on-site versus remote patient navigator on pediatricians' referrals and families' receipt of resources for unmet social needs. The study involved analyzing the referrals made to the patient navigator, the number of successful contacts with families, and the enrollment of families in social needs resources to compare the effectiveness of on-site versus remote patient navigation.

Setting: The study was conducted in four federally qualified health centers (FQHCs) in an urban setting. The patient navigator worked on-site and remotely as she divided her time between these four FQHCs from May 2015 to June 2019.

Population of Focus: The target audience for the study includes healthcare professionals, particularly pediatricians and primary care providers, as well as professionals involved in patient navigation and social services. Additionally, researchers and policymakers interested in addressing unmet social needs in pediatric populations may find the study relevant. The findings of the study can inform healthcare professionals and organizations about the effectiveness of on-site versus remote patient navigation in addressing the social needs of pediatric patients and their families.

Sample Size: The study included a total of 414 parents who were referred to the patient navigator during the study period. This sample size was used to assess the impact of on-site versus remote navigation on the number of contacts with families and the enrollment of families in social needs resources.

Age Range: The age range of the referred patients in the study was 0-42 years old, but the average age was 1.7 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Patient Navigation, Enabling Services, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Provider Education, Designated Clinic/Extended Hours, Female Provider, COMMUNITY, Television Media, Other Media, POPULATION-BASED SYSTEMS

Intervention Description: Development and implementation of a multifaceted intervention using community-based participatory research (CBPR) methodology and evaluated with a quasi-experimental controlled design with cross-sectional pre-intervention (2000) and post-intervention (2004) telephone surveys. Data were analyzed in 2005.

Intervention Results: Significantly greater odds of Pap smear for women in intervention county than in control county (OR=2.02, 95% CI: 1.37-2.99)

Conclusion: A multifaceted community-based participatory research (CBPR) intervention was associated with increased Pap test receipt among Vietnamese-American women in one community.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Santa Clara County, CA and Harris County, TX

Population of Focus: Vietnamese women living in either county

Data Source: Computer-assisted telephone interviewing system

Sample Size: Baseline(n=1,566) Intervention (n=798); Control (n=768) Follow-up (n=2,009) Intervention (n=1,004); Control (n=1,005)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: To evaluate the effectiveness of an innovative reform in 2000 to the Dental Medicaid program in South Carolina.

Intervention Results: From 1998 to 1999, there was a downward trend in the number and percent of Medicaid enrollees ages 21 and younger receiving dental services and in the total number of services provided. This trend was dramatically reversed in 2000.

Conclusion: The January 2000 dental Medicaid reform in South Carolina had marked impact on Medicaid enrollees' access to dental services.

Study Design: QE: pretest-posttest

Setting: South Carolina

Population of Focus: Children aged 2-21 years enrolled in Medicaid

Data Source: Medicaid claims

Sample Size: 1998 (n=377,690) 1999 (n=447,069) 2000 (n=504,642)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Patient Navigation, Referrals,

Intervention Description: The first key MHQI strategy was a mental health–social work (MH-SW) electronic referral (Fig 1) through the shared EHR, implemented in September 2014. The electronic referral allows medical providers to make a direct referral to on-site mental health or social work services. The second significant MHQI strategy was a social work follow-up protocol, first implemented in December 2014, which has iteratively evolved over time (Fig 2). This begins with either a warm referral or through accessing the weekly electronic referral report. Then, the social worker communicates with each patient and offers options on the basis of the patient’s needs, which may include referrals to outside resources, care coordination, or brief counseling or therapy within the clinic and assistance with appointment scheduling.

Intervention Results: Rates of patients scheduling first appointments remained steady. First appointment show rates improved from 51% to 78%. Overall use of mental health appointments increased initially then lowered when emphasis shifted to treatment readiness before scheduling. Overall show rates for mental health appointments improved from 67% to 77%.

Conclusion: The electronic referral and social work protocol, along with other collaborative strategies, helped facilitate improved uptake and use of mental health services within an integrated care setting.

Study Design: Quantitative analysis of quality improvement data over 26 months Intervention: Implementation of 1) an electronic referral to mental health and social work services integrated into the electronic medical record; and 2) a social work follow-up protocol to coordinate referrals and assist patients in accessing treatment.

Setting: Adolescent primary care clinic at an academic medical center

Population of Focus: Adolescent patients ages 12-17

Sample Size: Referral and appointment data, sample size not reported

Age Range: 12-17 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation (Assistance), Shortened Appointment Interval

Intervention Description: Participants were randomized with 1:1 allocation to 2 arms. In the control arm, participants were instructed to schedule their routine visit at 6 weeks after delivery (defined as 29–56 days after delivery). Participants in the intervention arm were instructed to schedule a visit at 2 weeks after delivery (8–28 days after delivery) in addition to 6 weeks after delivery.

Intervention Results: The attendance at 1 or more postpartum visits was not significantly different among the control and intervention arms (58% vs 70%; P=.065). The 2-week visit had an attendance rate of 41% (51 of 125), and the 6-week visit had an attendance rate of 60% (151 of 250). After adjusting for confounders, significant predictors of postpartum visit nonattendance included younger age, multiparity, and being a patient from the high-risk obstetrical clinic. The rate of emergency department visits was similar between the control and intervention arms (8% vs 6%; P=.635). However, more patients in the control arm come to the clinic for nonroutine visits (30% vs 16%; P=.010). In response to a patient satisfaction survey on the optimal timing of the postpartum visit, most respondents (59%) would have preferred both the 2- and 6-week visits.

Conclusion: The addition of a 2-week postpartum visit to the 6-week postpartum visit did not increase the likelihood of attendance of patients in a routine visit but did decrease the number of urgent clinic visits.

Study Design: Parallel, randomized, nonblinded trial

Setting: Publicly insured clinic in a tertiary academic medical center

Population of Focus: Postpartum patients

Sample Size: 250

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, Concurrent Infant/Mother Checkups

Intervention Description: Following randomization, participants in the mommy-baby visit arm were scheduled for a co-located, co-timed postpartum/well-child visit at 4 weeks after delivery designed through a partnership between obstetrics and pediatrics. The pediatricians performed the infant's checkup either in the same patient room as the mother's obstetric visit or in the adjacent pediatric practice immediately before the postpartum visit. Women randomized to the control group received usual postpartum care, separate maternal and child visits. Their usual care was “enhanced” in that study staff scheduled participants' postpartum visits before hospital discharge.

Intervention Results: One hundred sixteen women, of whom 76.7% (n = 89) were Latina immigrants, were enrolled postdelivery and randomized to a mommy-baby visit (n = 58, 49.5%) or to enhanced usual care (n = 58, 50.4%). Almost all study participants attended their postpartum visit (n = 109, 94.0%). There was no significant difference in postpartum visit attendance rate by randomization assignment (91.4% of mommy-baby vs. 96.6% of enhanced usual care participants). Study participants, mommy-baby intervention and enhanced usual care arms combined, were significantly more likely to attend the postpartum visit than historical controls (94.0% vs. 69.7%, respectively, p < 0.001).

Conclusion: In a randomized controlled trial, we showed postpartum visit attendance rates were high for participants in both the mommy-baby and enhanced usual care arms. Postpartum visit scheduling assistance was provided to all participants and may have increased postpartum visit attendance and thereby attenuated the effect of the intervention. It is encouraging that a low-cost, low-tech, low-touch intervention, that is, postpartum appointment scheduling before hospital discharge, could increase postpartum visit attendance.

Study Design: Randomized control trial

Setting: Large academic hospital in Baltmore

Sample Size: 116 low-income postpartum women with limited English-langauge proficiency

Age Range: >18

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Access, Patient Navigation,

Intervention Description: The implementation of clinical-community linkages to engage Medicaid-insured pregnant women in underutilized home visiting services for enhanced prenatal care coordination.

Intervention Results: Clinical-Community Linkages: The Impact of Standard Care Processes that Engage Medicaid-Eligible Pregnant Women in Home Visiting. When compared with similar women from the rest of the state, the Federally Qualified Health Center observed a 9.1 absolute percentage points (APP; 95% confidence interval [CI], 8.1–10.1) increase in MIHP participation and 12.5 APP (95% CI, 10.4–14.6) increase in early first trimester enrollment. The obstetrics and gynecology residency practice experienced increases of 4.4 APP (95% CI, 3.3–5.6) in overall MIHP participation and 12.5 APP (95% CI, 10.3–14.7) in first trimester enrollment. Significant improvements in adequate prenatal care, emergency department use, and postpartum visit completion were also observed.

Conclusion: Clinical–community linkages can significantly improve participation of Medicaid-insured women in an evidence-based home visiting program and other prenatal services. This work is important because health providers are looking for ways to create clinical–community linkages

Study Design: Quasi-experimental design

Setting: A Federally Qualified Health Center (FQHC) and a hospital-based obstetrics and gynecology residency practice

Population of Focus: Medicaid-insured pregnant women; healthcare pracitioners

Sample Size: 1,017 (Combined FQHC and Ob/Gyn residency practice)

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation (Assistance),

Intervention Description: The intervention in the study involved the implementation of patient navigators (PNs) in a pediatric primary care practice. The PNs were bachelor's-level staff trained to assist with patient and family needs, such as referrals to Medicaid-sponsored transportation services, assisting parents in filling out challenging paperwork, and coordinating appointments. Providers referred patients to PNs via an order in the electronic medical record (EMR) or by paging the on-call PN. The PNs received training by social work staff, and biweekly, they met with clinic social work and nursing staff to review cases and iteratively learn from their experiences. The PNs' role was formalized in the fall of 2014 to focus on assisting families with adherence to follow-up visits and subspecialty referrals, accessing developmental services, overcoming transportation barriers, and transitioning to adult care. The study also distinguished PNs from both resource specialists, who handled concrete resource needs, and social work staff, who focused on more complex psychosocial concerns,.

Intervention Results: PNs tracked referral processes and a subset of PN referrals was assessed for markers of successful referrals. The most common reasons for referral were assistance overcoming barriers to care (46%), developmental concerns (38%), and adherence/care coordination concerns (14%). Significant predictors of referral were younger age, medical complexity, public insurance, male sex, and higher rates of no-show to visits in primary or subspecialist care. The majority of referrals were resolved. The referrals for process-oriented needs were significantly more successful than those for other concerns.

Conclusion: Yes, the study reports several statistically significant findings. For example, the study found that successful referral to patient navigators was significantly associated with private payor, Asian American ethnicity, medical complexity, younger age, type of patient navigator referral, provider type referring to patient navigators, longer time spent on referral, fewer no-shows, and more completed visits. Additionally, the study identified factors significantly associated with successful referrals to patient navigators on multivariate analysis, such as the reason for referral. These findings indicate the presence of statistically significant associations within the study.

Study Design: The study design is a retrospective analysis conducted in a clinical setting. It involves tracking the outcomes of patient navigator referrals and analyzing the factors associated with successful referrals. The study also includes demographic data on both referred and nonreferred clinic patients, indicating a retrospective observational study design.

Setting: The study was conducted at one large hospital-based pediatric primary care clinic serving more than 16,000 patients who are predominantly publicly insured and nonwhite. The clinic is located in an urban area.

Population of Focus: The target audience for the study is healthcare providers, administrators, and researchers who are interested in improving access to care for vulnerable populations, particularly children with medical complexity, low health literacy, or limited English proficiency. The study may also be of interest to patient navigators and other healthcare professionals who work with underserved populations.

Sample Size: The sample size for the study is not explicitly mentioned in the provided excerpts. However, the study mentions a subset of 1109 patient navigator referrals that were assessed for predictors of a successful referral. This subset represents a portion of the overall sample size used in the study.

Age Range: The age group discussed in the article varies, but it includes infants, toddlers, school-age children, and adolescents. The study found that referral to patient navigators was more likely for children under 3 years of age.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, Text Messaging,

Intervention Description: Navigating New Motherhood (NNM) was a patient navigation program that sought to increase the frequency of postpartum care attendance in a tertiary care center practice serving predominantly low-income, minority women. The NNM program provided postpartum appointment scheduling assistance, appointment reminders, assistance with logistical barriers, and social support to mothers. In accordance with patient preference, the NNM program relied predominantly on SMS text message communication between patient navigators and women enrolled in the program.

Intervention Results: While the program was in place, the majority of enrolled women (88.1%) returned for their postpartum visits at an average of 6.2 weeks postpartum. More frequent and multidimensional communication was associated with follow-up in a postpartum patient navigation program. Most women (98.2%) communicated with navigators via text message. Women who completed postpartum follow-up sent and received more texts than women who did not (7.8 vs. 3.7, p<0.001 and 11.5 vs. 8.0, p<0.05, respectively); exchange of ≥6 messages was associated with greater odds of follow-up (adjusted odds ratio 2.89, 95% CI1.13–7.41). Lack of patient response was also associated with lack of follow-up (p<0.001). Four categories of message themes were identified: Rapport-building, Postpartum Care Coordination, Maternal Health, and Motherhood. Message threads with more Rapport-building or Maternal Health messages were associated with more frequent patient follow-up (p<0.01 and p<0.05, respectively), as was average number of emoticons per message thread (2.1 vs. 1.2, p=0.01).

Conclusion: Findings illustrate that certain communication characteristics, including more frequent exchange of messages and greater use of rapport-building- or maternal health-oriented messages, are associated with an improved likelihood of return. Message frequency and message content appear to be critical communication features of effective patient navigation. Rapport-building messages were the most frequently observed type of communication across all message threads, and they were significantly more frequent among patients who ultimately completed follow-up. These results are consistent with previous studies emphasizing the importance of relational qualities and the ability to build trust within the patient navigation model

Study Design: Mixed methods secondary analysis

Setting: University tertiary care center in Chicago

Population of Focus: Women enrolled in public insurance receiving prenatal care

Sample Size: 218 women

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Patient Navigation, Enabling Services, Home Visits

Intervention Description: A randomized controlled trial to evaluate the effectiveness of two alternative cervical cancer screening interventions for Chinese women living in North America.

Intervention Results: Women in both intervention groups significantly more likely to have Pap smear than women in control group (39% in outreach worker group vs 15% in control, p<.001; 25% in direct mail group vs 15% in control, p=.03)

Conclusion: Culturally and linguistically appropriate interventions may improve Pap testing levels among Chinese women in North America.

Study Design: RCT

Setting: Seattle, WA and Vancouver, British Columbia

Population of Focus: Women who spoke Cantonese, Mandarin, or English, with no history of cervical cancer or hysterectomy, who were defined as underutilizers of cervical cancer screening (no Pap test in the past 2 years and/or did not intend to have a Pap test in the next 2 years)

Data Source: Self-report through personal interviews and verified through medical record review

Sample Size: Total (N=402) Intervention Group 1 (n=129); Intervention Group 2 (n=139); Control (n=134)

Age Range: 20-69

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Patient Navigation, Enabling Services, COMMUNITY, Community Events, POPULATION-BASED SYSTEMS, Home Visits

Intervention Description: A group-randomized controlled trial to evaluate a cervical cancer screening intervention program targeting Seattle’s Cambodian refugee community.

Intervention Results: The proportion of women in the intervention group reporting recent cervical cancer screening increased from 44% at baseline to 61% at follow-up (+17%). The corresponding proportions among the control group were 51 and 62% (+11%). These temporal increases were statistically significant in both the intervention (P < 0.001) and control (P = 0.027) groups.

Conclusion: This study was unable to document an increase in Pap testing use specifically in the neighborhood-based outreach intervention group; rather, we found an increase in both intervention and control groups. A general awareness of the project among women and their health care providers as well as other ongoing cervical cancer screening promotional efforts may all have contributed to increases in Pap testing rates.

Study Design: Cluster RCT

Setting: Seattle, Washington

Population of Focus: Cambodian women

Data Source: Self-report through personal interviews and verified through medical record review

Sample Size: Total (N=370) Analysis (n=289) Intervention (n=144); Control (n=145)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, PATIENT_CONSUMER, Educational Material

Intervention Description: We examine the efficacy of MARHABA, a social marketing-informed, lay health worker (LHW) intervention with patient navigation (PN), to increase breast and cervical cancer screening among Muslim women in New York City. Muslim women were eligible if they were overdue for a mammogram and/or a Pap test. All participants attended a 1-h educational seminar with distribution of small media health education materials, after which randomization occurred. Women in the Education + Media + PN arm received planned follow-ups from a LHW. Women in the Education + Media arm received no further contact. A total of 428 women were randomized into the intervention (214 into each arm).

Intervention Results: Between baseline and 4-month follow-up, mammogram screening increased from 16.0 to 49.0% in the Education + Media + PN arm (p < 0.001), and from 14.7 to 44.6% in the Education + Media arm (p < 0.001). Pap test screening increased from 16.9 to 42.3% in the Education + Media + PN arm (p < 0.001) and from 17.3 to 37.1% in the Education + Media arm (p < 0.001).

Conclusion: Cancer screening knowledge increased in both groups. Between group differences were not statistically significant for screening and knowledge outcomes. A longer follow-up period may have resulted in a greater proportion of up-to-date screenings, given that many women had not yet received their scheduled screenings. Findings suggest that the educational session and small media materials were perhaps sufficient to increase breast and cervical cancer screening among Muslim American women.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, Text Messaging,

Intervention Description: The patient-centered Navigating New Motherhood program hired one full-time patient navigator who was experienced navigating low-income women through women's health cancer screening and treatment. The navigator coordinated with clinic staff to schedule the patient's six-week postpartum appointment as well as any earlier visits recommended by the medical team. Appointment times were communicated in person or by phone, text, or email, per patient preference. Reminders were sent by the navigator one week after delivery, one week prior to appointment, and one day prior to the appointment. The navigator offered additional services as needed, including connection to health care providers for maternal or neonatal clinical concerns, psychosocial support, appointment and logistical support, assistance with social work needs (such as identifying food or transportation resources), or connection to mental health care providers. Additionally, during the postpartum hospitalization, the navigator offered brief written and verbal counseling about the benefits of and options for contraception and breastfeeding.

Intervention Results: The primary outcome, return for postpartum care, was more common among women in Navigating New Motherhood (88.1% compared with 70.3%, P<.001), a difference that persisted after adjustment for potential confounding factors. Women in Navigating New Motherhood were also more likely to receive a WHO Tier 1 or 2 contraceptive method, postpartum depression screening, and influenza and human papillomavirus vaccination.

Conclusion: Implementation of a postpartum navigation program was associated with improved retention in routine postpartum care and frequency of contraception uptake, depression screening, and vaccination.

Study Design: Prospective observational study

Setting: Medicaid based university clinic

Population of Focus: Patients receiving prenatal care

Sample Size: 218 in intervention group; 256 in historic cohort

Age Range: ≥18 (29 mean age)