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ER Navigation

About the Program

COPE ProgramMemorial Hermann hospitals collaborated with U.T. School of Public Health for a Houston hospitals' ER Use Study that revealed 40 percent of all treated and released visits are primary care related.

In 2008, Memorial Hermann Community Benefit Corporation launched the ER Navigation Program to address the problem of inappropriate ER use.

ER Navigation places a Community Health Worker (CHW) in Memorial Hermann ERs that are used heavily by uninsured/underinsured patients to identify more appropriate health facilities.

Services Offered

CHWs identify clinics that are the best fit for a patient's location, income, language, work hours and bus routes, and address issues that may lower the priority of health care (e.g., need for food stamps, rental support or assistance with utilities). They make appointments, arrange transportation, share information and referrals to community/safety net programs, and educate about public benefits and other payment resources.

While CHWs initially meet patients during an ER visit, much of their work is done in follow-up; ensuring a clinic appointment was made/ was successful and assisting with paperwork required for qualification for Medicaid, CHIP or county indigent programs.

Program Goals

The primary goal is to find an appropriate Health Home for patients and provide resources to navigate future concerns. 

Patients in a twelve month pre/post navigation intervention timeframe experienced a 64.7% reduction in ER visits as compared to pre-ER activity after navigation assistance from community health workers.

Navigated patients returning to MH EDs decreased post-intervention, including patients with 5+ pre-intervention visits.

12 Months Pre-, Post-Intervention

Number of VisitsDistinct Patients (N) Pre-*Distinct Patients (N) Post-% change
Total Patient (N)23,8538,43264.7%

*Day of intervention visit included in pre-intervention total.

Mean visits to MH EDs by navigated patients decreased significantly* from pre- to post-intervention, except for those with 5+ pre-intervention visits.

12 Months Pre-, Post-Intervention

Number of Visits, Patients (N)Mean (Pre)Mean (Post)Difference
1** visit (N=16,280)1.000.44-0.56*
2 visits (N=4,452)2.000.98-1.01*
3 visits (N=1,533)3.001.49-1.51*
4 visits (N=699) 4.002.06-1.94*
5 or more visits (N=889) 10.368.98-1.37
Total patients (N=23,853) 1.750.97-0.79*

*Mean difference significant at alpha ‹0.001.
**Visit occurred on day of intervention.

Awards and Recognitions

One of five Memorial Hermann programs contributing to recognition as a finalist for the 2013 Foster G. McGaw Prize for Excellence in Community Service.

Publication in the Journal of Healthcare Management, Nov./Dec. 2013, Reducing Preventable Emergency Department Utilization and Costs by Using Community Health Workers as Patient Navigators, Kimberly R. Enard, UTHealth School of Public Health and Deborah M. Ganelin, Memorial Hermann.