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In October 2012, the Hospital Readmissions Reduction Program began as part of the Patient Protection and Affordable Care Act (ACA) to reduce hospital readmissions. Hospitals were challenged with providing care transitions to decrease 30-day hospital readmission rates, or be subject to monetary fines (Akerele et al., 2017; Centers for Medicare & Medicaid Services, 2020; McIlvennan et al., 2015). "Hospital readmissions are associated with unfavorable patient outcomes and high financial costs" (McIlvennan et al., 2015, p. 1796).
All-cause general hospital readmission rates in the United States dropped 7% for Medicare patients from 2010 to 2016. Uninsured patient readmission rates increased 14%, while Medicaid and private insured patient rates remained the same (Bailey et al., 2019). Because of changes to healthcare regulations after implementing the ACA, hospitals now incur decreased reimbursements from Medicare for high rates of hospital readmissions. Hospital leaders are challenged with identifying and implementing effective strategies for reducing readmissions. The use of nurse navigators has been found to reduce readmission rates and affect costs positively (Agency for Healthcare Research and Quality [AHRQ], 2020; Akerele et al., 2017; Di Palo et al., 2017; Poston et al., 2014; Razali et al., 2017). Current literature on patient navigators and their effect on hospital readmissions will be reviewed.
Roles and Uses of Navigators
The responsibilities and qualifications of the patient navigator vary across healthcare systems and settings. In some instances, the navigator intervention is performed by a non-nurse community health worker (CHW) who is a lay patient advocate from the community or a peer coach (Prieto-Centurion et al., 2019). A non-nurse CHW patient navigator may reduce readmissions (Balaban et al., 2015) and healthcare costs for older adults (Galbraith et al., 2017) while also being a less-costly alternative to a nurse navigator. The CHW may provide patient navigation through post-discharge patient outreach, coaching, assistance with medications, appointment scheduling, transportation, and communication with the primary care provider (Balaban et al., 2017).
A typical nurse navigator is a clinician who is responsible for the facilitation and coordination of care services for a particular population (Seldon et al., 2016). The nurse navigator also may be specialized for specific chronic disease management. Roles and responsibilities in a nurse navigator program for heart failure (HF) may include providing education, acting as a patient liaison...