Increased cost of chronic illnesses in United States is an urgent call to develop a cost effective approach to improve chronic disease self-management, especially among vulnerable populations. An emerging role for professionals and paraprofessionals is the patient navigator. We present an example of a conceptual framework, Transformation for Health, developed to underpin the training of certified community health workers (CHW) to deliver health care, preventive services, and health education for underserved populations to promote chronic disease self-management. Transformacion Para Salud (TPS), a patient navigation model for chronic disease self-management, was a two year demonstration program to develop a culturally sensitive intervention to facilitate patient behavior changes. Patients involved in the TPS intervention showed improvements in clinical and behavioral outcomes after twelve months of intervention. This article describes the conceptual basis and implementation of the TPS and discusses program evaluation, specific intervention outcomes, and implications for practice. Use of CHWs in the patient navigator role demonstrated a cost effective method to improve access to quality, cost-effective, primary health care services as well as to facilitate chronic disease self-management.
Citation: Esperat, M. C., Flores, D., McMurry, L., Feng, D., Song, H., Billings, L., Masten, Y., (May 31, 2012) "Transformacion Para Salud: A Patient Navigation Model for Chronic Disease Self-Management" OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 2, Manuscript 2.
Key words: chronic care model, chronic disease self-management, community health worker, transformation for health, Transformacion Para Salud
The Transformacion Para Salud (TPS) experience describes a new paradigm to facilitate behavior change among people with chronic diseases though use of a trained patient navigator. This model can accommodate ideas and concepts from other existing theories of behavior. Behavior change among people suffering from chronic disease is needed so that they can effectively manage their condition(s).
The impact of this transformation can be inferred in economic terms. The United States spent $2.1 trillion on health care in 2006, an amount that represents 16% of the nation's the gross domestic product. Much of the $2.1 trillion dollars spent was on chronic diseases since 133 million people, almost half of all Americans, lived with at least one chronic condition (Catlin, Cowan, Hartman, Heffler, & National Health Expenditure Accounts Team, 2008; Thorpe & Howard, 2006). Costs that were spread out for hospital care, physician and clinical services, and prescription drugs represented 62% of that total spending.
The impact of chronic illness is greater than economic terms alone; chronic diseases account for one third of potential life lost before the age of 65 years (Centers of Disease Control and Prevention, 2007). The impact of chronic disease and its consequences is much more acute impact among vulnerable populations, such as uninsured African Americans and Hispanics. Vulnerability to poor health is the result of interactions of many factors (Anderson & Knickman, 2001) encompassing individual, community, social, and political variables that impinge on individuals and groups in various ways. Among these factors, socio-economic variables are some of the most highly influential. The official poverty rate in 2007 was 12.5% with 37.3 million people in poverty, up from 36.5 million in 2006 (DeNavas-Walt, Proctor, & Smith, 2008). Viewed within this context, the potential impact of an innovative approach to health behavior change, such as the TPS, can be significant in chronic disease self-management among vulnerable individuals.
Implications for Health Care Reform
One obvious avenue for significant cost savings to the health care system is to prevent episodes where health care costs the most: hospitalizations and hospital readmissions. …