Community Health Navigators (CHNs) are defined as community health workers that provide
patient navigation. Based on evidence to date, CHNs for chronic disease management are
likely to beneficially impact patient experience, clinical outcomes and costs; however,
contextual evidence is lacking given that most studies to date have been conducted in the
United States. In Canada, patient navigation programs currently exist in only a few
settings (primarily cancer treatment and transitional care), with few navigation programs
implemented in chronic disease care.
The ENCOMPASS program of research was initiated in 2016, when researchers with the
University of Calgary's Interdisciplinary Chronic Disease Collaboration partnered with
Mosaic Primary Care Network (PCN) to develop, implement and evaluate a community health
navigation program for patients with multiple chronic conditions. The program was based
on a systematic literature review and refined in consultation with key stakeholders. A
cluster-randomized controlled trial is currently ongoing with Mosaic PCN to determine the
impact of the program on acute care use, patient-reported outcomes and experience, and
disease-specific clinical outcomes (NCT03077386).
Alberta Primary Care Networks (PCNs) are comprised of groups of family physicians and
other health care professionals working together to provide comprehensive patient care to
Albertans. To understand if the community health navigation program can be feasibly
scaled and spread to PCNs across Alberta, we are expanding research to examine and
evaluate community health navigation program implementation to other geographic areas and
populations. This study expands the ENCOMPASS program of research to Edmonton Oliver PCN,
which represents over 170 physician members and serves approximately 131,000 patients.
The current study employs the RE-AIM framework (reach, effectiveness, adoption,
implementation, and maintenance) to examine the scalability of the community health
navigation program.
The objectives of this study are to (1) assess the impact of the intervention on the
target population and health system (effectiveness); (2) explore the feasibility and
appropriateness of practical intervention scale-up (reach, adoption, implementation, and
maintenance), and (3) identify the required resources and infrastructure necessary to
maintain and scale the intervention provincially.
The effectiveness of the community health navigator program will be studied using a
two-armed, pragmatic, randomized waitlist-controlled trial. This study will employ
patient-level block randomization with research staff blinded to block size.
Randomization will be concealed and computer-generated. Primary outcomes will be assessed
using administrative health data. Secondary outcomes will be measured using a patient
health survey administered by a research assistant at baseline, 6 months, and 12 months.
A concurrent qualitative study will provide contextual information on the effectiveness
of the community health navigator program from patient, provider, and CHN perspectives.
Process evaluation metrics and interviews with program stakeholders will inform the
feasibility and sustainability of the community health navigator program in Alberta PCNs.
