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Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti

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Abstract

Introduction

In the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program.

Materials and methods

Patient navigators were trained to guide subjects from a mountain population through the entire hospital process for elective surgery. We compared the rate of elective operations before and after the patient navigation intervention between three groups: a control group from a mountainous area, a control group from the plains and an intervention group from a mountainous area.

Results

The baseline elective operation rate differed significantly between the plains control group, the mountain control group and the mountain intervention group (361 vs. 57 vs. 68 operations per 100,000 population per year). The rate of elective surgery between the two mountain groups was not statistically different prior to the intervention. After the intervention, the elective operation rate in the mountain group that received patient navigation increased from 68 to 131 operations per 100,000 population per year (p = 0.017).

Discussion

Patient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.

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Funding

Funding was provided by Swiss Partnerschaft HAS Haiti, and the Partners Healthcare Center of Expertise in Quality and Patient Safety.

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Authors and Affiliations

  1. The Center for Surgery and Public Health, Brigham and Women’s Hospital, One Brigham Circle, Suite 4-020, 1620 Tremont Street, Boston, MA, 02120, USA

    Alexi C. Matousek, Stephen R. Addington, Stuart Lipsitz & Robert Riviello

  2. The Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Alexi C. Matousek, John G. Meara & Robert Riviello

  3. Hospital Albert Schweitzer, Deschapelles, Haiti

    Joseph Kahan, Herriot Sannon, Thelius Luckner, Chauvet Exe & Rodolphe R. Eisenhower Jean Louis

Authors
  1. Alexi C. Matousek
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  2. Stephen R. Addington
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  3. Joseph Kahan
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  4. Herriot Sannon
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  5. Thelius Luckner
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  6. Chauvet Exe
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  7. Rodolphe R. Eisenhower Jean Louis
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  8. Stuart Lipsitz
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  9. John G. Meara
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  10. Robert Riviello
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Corresponding author

Correspondence to Alexi C. Matousek.

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The authors report no conflicts of interest.

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Matousek, A.C., Addington, S.R., Kahan, J. et al. Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti. World J Surg 41, 3025–3030 (2017). https://doi.org/10.1007/s00268-017-4246-6

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  • DOI: https://doi.org/10.1007/s00268-017-4246-6

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