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Improving Well-being for Heart Transplant Recipients: Implementation of a Patient Navigator Program

K. Ramonas, K. Ramonas

Health Navigator Foundation, San Francisco, CA

Meeting: 2021 American Transplant Congress

Abstract number: 1287

Keywords: Heart transplant patients

Topic: Clinical Science » Organ Inclusive » Non-Organ Specific: Disparities to Outcome and Access to Healthcare

Session Information

Session Name: Non-Organ Specific: Disparities to Outcome and Access to Healthcare

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: When surveyed, heart transplant recipients cited managing all their healthcare needs as a primary concern 83% of the time (n=23). To respond to this need, a patient navigator program was created. We aim to show that providing individualized navigator services following discharge from the hospital post heart transplant improves well-being for recipients.

*Methods: All heart transplant recipients at a single center, identified prior to discharge, were eligible for enrollment and offered navigation services. The program provides individualized interventions for 4-6 weeks following hospital discharge, at no additional cost to recipients. Services provided include: immediate phone, email, or HIPAA compliant text access to a patient navigator team, personal escort to lab draws, tests and procedures, and navigator accompaniment to outpatient appointments. The navigator program also provided: medication organizers, vital sign and symptom log, meal delivery, local resource guide, caregiver support, translation services, social work support, peer networking, and community resource referrals. Average navigator time dedicated to each patient varied but ranged 1-4 hours/week. All recipients completed a pre- and post- enrollment quality of life survey as well as an exit interview about program services. We utilized the organ transplant symptom and well-being instrument (Forsberg, et al., 2012)

*Results: In this pilot study, 23 patients enrolled in the program over an 18 month period and completed a pre program survey. 19 recipients completed a post program survey after receiving navigation services. Pre program, the average quality of life reported was 47 on a 100 point scale. 78% of respondents reported they could not complete desired activities. Post program, 100% of patients reported their quality of life to be better than expected. 78% believed the program contributed to their success. 90% of participants would recommend the program to others.

*Conclusions: Results from this pilot suggest a positive impact of the patient navigator program in a heart transplant recipient population, particularly in its ability to meet individual needs and immediate access to a team member. Future work with a larger sample size is indicated to more fully assess the program’s impact on quality of life. Preliminary data suggest implementation of a patient navigator program contributes positively to heart transplant recipients’ health and well-being. Individualized navigation programs could be effective in improving well-being for a wide range of patients with critical illnesses.

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To cite this abstract in AMA style:

Ramonas K, Ramonas K. Improving Well-being for Heart Transplant Recipients: Implementation of a Patient Navigator Program [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/improving-well-being-for-heart-transplant-recipients-implementation-of-a-patient-navigator-program/. Accessed May 11, 2025.

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