Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Promotion

First Committee Member

Dr. Dejun Su

Second Committee Member

Dr. Regina Idoate

Third Committee Member

Jennifer Mayhew


Background. Low-income persons are subject to barriers to accessing health care and the additional complexity of the referral process, specifically for those receiving assistance from indigent care programs, contributes to those barriers. The requirements for patients receiving social assistance from indigent care programs leads to increased waiting time to be seen by specialists and contributes to health disparities.

Aim. Through a partnership with OneWorld Community Health Centers this project seeks to understand the efficacy of the implementation of a “referral navigator” at OneWorld and make recommendations to enhance the process. The proposed navigator is aimed to decrease the waiting time between the date of referral by the physician and the date on which the patient is eligible to be scheduled at a specialist’s office through HOPE.

Methods. Individual interviews were conducted with three referral care coordinators, recorded, transcribed, and coded for emergent themes. In addition, individual chart review was completed in order to determine the frequency for which referrals were being tasked or not tasked. Patient outreach was also piloted in order to assess the efficiency and feasibility of calling patients. The data were summarized using frequency tables and a SWOT analysis was conducted for easier identification of factors that impact the referral process.

Results. Interviews with referral care coordinators (RCCs) led to informative conversations that mirrored the sentiments originally presented by the Patient Voice Committee. It was identified that approximately 36% of referrals are not tasked and these non-tasked referral lead to an average initial contact time frame of roughly 24 days. Patient outreach was unproductive due to an only 8% successful patient outreach, 36% of patients were unreachable, and 20% were left a message. From this data, we were able to better understand the efficacy of the implementation of a “referral navigator” at OneWorld and how to reduce the waiting time between the date the referral was entered and the date on which the patient is eligible for an appointment through HOPE. Recommendations of providing a communications refresher training, implementing a referral packet, and implementing a modified referral navigator position were made in order to achieve the aims of this project.

Conclusion. Through the pilot evaluation, areas of improvement were identified in order to enhance the referral process. Interventions targeting improvements in communication and follow-through between staff members have the potential for greatest impact on maximizing efficiency. Using the SWOT analysis tools to better visualize the problem, future interventions can be designed and adjusted as needed.

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