Although most Americans wish to die peacefully at home, many die in pain and in the hospital. A quarter of
Medicare dollars – over $100 billion - is spent for patients in their last year of life many are cancer patients. In
brief, there is a desperate need for higher quality, more affordable, better patient-centered care for severely ill
and dying patients. Effective palliative care for dying and severely ill patients meets this need. Additionally,
improvements in the quality of US health care have not equally benefitted low income and minority patients,
who remain more likely to have worse health care experiences and outcomes across the spectrum of clinical
settings and diseases. Patient navigator programs, in which lay health workers help patients navigate the
system, have shown promise for improving quality of care among specific patient populations, but are not
widely implemented due to cost and disease-specific content. A less costly, more broadly applicable program
would have the potential to improve quality and outcomes for a larger population. The long-term objective of
the K08 candidate, Fabian Johnston, MD, MHS, is to improve health care quality, experiences and outcomes
for underserved patients by developing and evaluating systems-oriented, family- engaged interventions with
potential for broad population impact. This goal is consistent withAHRQ, NCI, and PCORI, priority areas of
improving implementation of models of care, utilization of stakeholder engagement, reduction of disparities and
improved use of palliative care.
To achieve his objective, Dr. Johnston will undertake didactic and experiential training to improve knowledge
and skills in four areas: (1) patient navigation; (2) participant-engaged program development and research; (3)
comparative effectiveness and stakeholder engagement; and (4) dissemination and implementation science.
Dr. Johnston has assembled a mentorship team with expertise in health care quality research,
disparities, patient navigation, palliative care, stakeholder engagement and participant-engaged research, to
ensure completion of the proposed research and training and successful transition to independence. Dr.
Johnston proposes three sequential, innovative projects that build upon his training goals. These projects will
contribute to the development and pilot evaluation of a culturally tailored navigation program for African
American patients with advanced solid organ malignancies, targeted to the advance care planning, pain
management, and hospice referral. The specific aims are: (1) to collaborate with key stakeholders to develop a
targeted patient navigation program; (2) to pilot test the culturally tailored patient navigator intervention; and (3)
toassess the feasibility, acceptability, cost, and impact of patient navigation as assessed by a vanguard
randomized trial among African American patients with advanced malignancies.
This proposal is novel in its
application of patient navigation to patients in need of palliative care; and in its use of stakeholder engagement
to aid in adaptation of navigation into a briefer, less costly intervention to facilitate dissemination.
No terms available