Background:

Medical center-based Community Health Workers, also known as Patient Navigators (PNs), play a vital but varied role in comprehensive care within adult sickle cell disease (SCD) medical homes. Depending on the need of the moment, they may address barriers to care, may enhance patient engagement, or may improve healthcare utilization efficiency. However, little is known about how PNs allocate their time across these diverse activities in adult SCD medical homes. We describe and analyze how PNs in a large urban medical center distributed their time among patients over several years, in order to maximize the efficiency of their care coordination, social support, administrative tasks, and direct patient interactions.

Methods:

PN contact data from 2020 to mid-2025 were analyzed to evaluate time utilization patterns, contact types, and support activities. Contact duration was summed by MRN and year to accommodate changing High Utilizer status annually. Wilcoxon rank-sum tests were used to compare PN time between high utilizers and non-high utilizers each year, as well as between patient-initiated and PN-initiated contacts. Descriptive analyses were performed to assess average contact time by visit type, frequency of contact settings, telecommunication usage, and the distribution of contact topics and assistance types over time.

Results: Usage Analysis of summed contact duration by MRN and year shows that high utilizers tend to use more PN time compared to non-high utilizers. Since the composition of high utilizers changes annually, breaking the analysis down by year is crucial. The Wilcoxon test p-values across years vary, with statistically significant differences emerging in 2021 (p=0.05), 2022 (p=0.002), 2023 (p<0.0001), and 2024 (p=0.02), suggesting that in those years, high utilizers had notably longer contact durations. The lack of significance in 2020 and 2025 (p=0.48 and p=0.72 respectively) may reflect cohort overlap, data sparsity, or true absence of group differences. Patient-initiated contacts required considerably more PN time comparing to PN-initiated contacts. This suggests that when patients take the lead in initiating contact, the interactions tend to be more time-consuming, potentially due to more complex needs or less structured communication. The finding emphasizes the resource intensity of patient-driven outreach. Average duration by visit type averaging contact time over the last five and a half years shows that community visits consume approximately one hour per visit—making them one of the longest contact types. In contrast, ambulatory visits require the least amount of time. This may reflect the nature of community interactions, which often involve broader psychosocial engagement and travel time, contrasting with shorter, more task-focused contacts in clinical settings. Appointment-related issues dominate PN interactions, comprising 45.2% of topics. Emotional support (18.1%) and medication concerns (16.9%) follow, highlighting logistics as the core focus, with emotional and medication support as key secondary areas. Assistance Received Frequency The majority of patients (57.7%) received help with prescriptions, making it the most common support activity. Secondary tasks included reviewing medication routines (24.4%) and managing early refills (7.1%), underscoring the PN's key role in medication management.

Conclusion: PN contact time allocation in an Adult SCD Medical home reflected evolving program priorities and an expanding patient population. In 2018, we interpret that PNs used high-touch to manage the program's highest priority patients–a relatively small group of high utilizers. They provided intensive, individualized support to reduce utilization of this high-utilizing group. However, in 2019, the program grew, and PNs transitioned toward reaching a broader patient base with slightly less intensive engagement per individual. In 2020 the program saw PNs make a major scale-up to contact more patients. This may have reflected a pandemic-related shift toward frequent, shorter interactions to maintain ongoing touchpoints during periods of disruption. Last, 2022-2024 statistics suggested PNs made further efforts to streamline interactions and maintain contact efficiency, potentially to accommodate more patients yet maintain some level of personalized support. We interpret these years represented a mature program phase, where PNs balanced scalability with meaningful patient engagement.

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2025
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