WINTHROP-UNIVERSITY HOSPITAL’S
New Center Navigates Patients Through the Healthcare Maze
STORY BY MAUREEN TRAXLER
Photo by Miranda Gatewood

COVER PHOTO CREDIT Miranda Gatewood

Nancy B. Langdon, RNC, BSN, MPH, patient navigator, clinical coordinator, Center for the Advanced Care of Chronic Conditions, Daniel Walsh, president, CEO, Winthrop-University Hospital and Dr. Michael S. Niederman, MD, chairman, Department of Medicine, Winthrop-University Hospital

Winthrop-University Hospital recently launched its Center for the Advanced Care of Chronic Conditions—a part of the hospital’s continuing commitment to address changing and emerging community healthcare needs. With estimates predicting that by 2015, two-thirds of the population, especially Baby Boomers, will have one or more chronic conditions, the Center seeks to help patients by reviewing their diagnoses with the input of outstanding physicians and healthcare providers, developing an individualized care plan, informing them of treatment options and therapies, and offering ongoing support so patients may live as healthfully and independently as possible. The key to the Center’s approach is its introduction of a “patient navigator,” who works one-on-one with a patient to coordinate his or her care.

“Healthcare settings are [currently] treating a patient’s major chronic condition, but without navigation—opening up the tree and looking at all the branches into which that one illness can lead,” notes Nancy Langdon, clinical coordinator of the Center and its first patient navigator. “It’s very rare for patients to have just one chronic condition; they usually have two or more.” For example, if a person has diabetes and a proper regimen is not maintained, heart or kidney problems may occur; with obesity, lung, heart, kidney or liver problems could be experienced.

Winthrop-University Hospital President and CEO Dan Walsh began thinking about helping people with chronic diseases a year-and-a-half ago. He brought the idea to Dr. Michael Niederman, chairman of the Department of Medicine at Winthrop, who refined it to chronic “conditions” and added the element of “a guide” who would help the patient become restored to his or her best possible health. “Dr. Niederman and Nancy Langdon gave my idea shape,” remarks Walsh. “They gave it life and put their imprint on it.”

Niederman and Walsh were also concerned about the current economy and its impact on healthcare and patients. They believe that if patients with chronic conditions are managed and seen by the appropriate disciplines, people would be spared unnecessary testing and doctor and emergency room visits, and cost-effective savings would be accomplished.

“The hospital was very methodical in researching existing facilities and patient needs, and in establishing the Center, which is “unique on Long Island and beyond,” says Langdon. “There isn’t anything quite like it,” confirms Niederman. Called “a center without walls,” the Center gives Langdon the scope to seek or confirm diagnoses, review treatment and explore advanced options not only at the Winthrop campus, but also at facilities and physicians’ offices on Long Island and in Manhattan.

Recognizing the quality of the program and the community response to its opening, a donor contributed a significant gift, which has enabled Winthrop to cover the salary and benefits of a second navigator, Karen Janovsky. Langdon’s services are paid by the hospital.

Developing a care plan
The Center specializes in treating a range of conditions that include chronic obstructive pulmonary disease and asthma, chronic renal failure, congestive heart failure, diabetes and obesity, multiple sclerosis and rheumatoid arthritis. Patients of any age can receive services, and Langdon says she has patients in their twenties and in their eighties. The Center welcomes people who use Winthrop’s services or have used them, as well as anyone who needs help managing their chronic condition or seeks a second or third opinion. “Sometimes people need to know their team is doing everything right,” says Langdon, a Registered Nurse with a Master’s degree in Public Health and certifications in gerontology, nursing home administration and mental health and case management. “Now they have peace of mind, knowing that at least they didn’t leave out a piece that could have given them 10 or 15 more years.”
New patients participate in a two-hour, free-of-charge intake session, in which Langdon reviews medical records patients may bring. If patients don’t have records on hand, she will help the patient begin a recorded file and keep it active. “At this point,” she says, “I start patient education.” She emphasizes that patients “need to be their own advocate” and encourages them to keep a journal of doctor visits and tests, and ask for a summary of results and assessments.

Langdon uses the “three Fs” to describe many of the people she sees: fearful, frustrated and fatigued. They are fatigued and frustrated by multiple doctors’ visits and fearful often because they just “don’t want to know.” She considers her assessment of patients, their background, what they want to accomplish and hold on to, as valuable information that will allow her to develop a relationship and a care plan, as well as introduce her patients to the appropriate physicians and providers she contacts. Langdon learns about diagnoses and when they occurred, and reviews medications. She says, “It’s very common to see people over 55 on 15 or more medications, not counting Tylenol or vitamin supplements,” usually because doctors are unaware that the patient is taking a medication prescribed by another doctor. Keeping in mind the patient’s schedule—work, school or other life commitments—Langdon sets up appointments for evaluations and tests paid for through the patient’s own health insurance, and she’s there to explain and help the patient understand results.

“It’s a solid foundation,” remarks Langdon. “It’s about good communication between practices, less visits, less diagnostics, less fear for the patient, and less mishaps. The stepping stones are laid by the navigator, one by one.”

Advanced care
“Winthrop has ‘tie-ins’ to advanced treatments,” notes Niederman, including new and emerging therapies and a wide array of clinical trials. For instance, Winthrop’s relationship with Manhattan’s Columbia University Hospital, the destination of many Long Island patients seeking kidney transplants, allows Winthrop to be “a bridge to Manhattan,” says Langdon. “We want to make treatment as seamless as possible.” Patients can come to Winthrop for pre-screening and blood work, and to meet their clinical transplant team. “The relationship with Columbia is an amazing leap in healthcare.”
Winthrop’s knowledgeable staff and researchers are equipped to discuss with patients the possibilities of clinical trials. “For some people, it may save their lives,” notes Langdon. “Clinical trials can open doors to many people who are used to doors being shut, options being off the table.” She adds that clinical trials are not just seeking statistics, but based on the patient’s medical outline, past, progression of the disease, activity after remission, and current state of organs, trials can offer patients something that has worked for people just like them.

“Transplant options and clinical trials are dark areas for people, but not for people at Winthrop. Here, it’s bright; there are possibilities, options, and alternatives. We’re very pro-active,” says Langdon.

Beyond doctors and testing
The Center’s patients not only have a “navigator,” but they also have a healthcare partner. Langdon says that even after patients complete their assessments, she reaches out to them almost weekly by phone. Patients are given access to the Center’s 24/7 telephone hotline where they can reach Langdon directly—eliminating the usual wait for a doctor or someone to locate a chart. Patients often call because they are unsure about a coming treatment or test, a medication or the meaning of a vital sign. Without the Center’s support and comfort, patients might otherwise unnecessarily end up in the emergency room.

“Once the patient has my number, he or she has it for life,” says Langdon, “because they’re going to have their chronic condition for life. They’ll be with me for as long as they choose.”
Using 21st Century technology, patients contact Langdon via email or text messages. “Text messaging is a great advantage for younger patients,” she adds. “What other health institution sends text messages their patients?”

The Center also offers its patients wellness coaching as part of Winthrop’s belief that chronic disease can be maintained, and people can stay healthy, and remain in their homes and involved with their quality of life. Langdon cautions that wellness support has to be timed correctly; for example, people with weight management conditions may not be ready to hear about the benefits of a health club for a year-and-a-half after being introduced to the Center. But wellness doesn’t only mean an exercise regimen; it can mean medication management, diet, nutrition and classes to de-stress. Langdon notes Winthrop’s commitment through the establishment of its Wellness Pavilion in Garden City, just blocks south of the hospital campus. In late February, a series of free lectures, each of six-week duration, began at the Wellness Pavilion, at which Langdon speaks and introduces the concept of the Center for the Advanced Care of Chronic Conditions.

“Winthrop made a commitment to health and a healthy lifestyle in partnering with Healthtrax at the Wellness Pavilion,” says Walsh. “We have an interest in having people get the most quality and function out of life. I see the new Center as a continuum…there’s an opportunity to serve the needs of people at the other end of the spectrum. It’s part of our philosophy.”

“We are very excited about the Center,” remarks Niederman. “We believe the program can be expanded, and hopefully in a couple of years, it will be a model of healthcare delivery for other communities.” For more information about the Center for the Advanced Care of Chronic Conditions, call 1-866-WINTHROP.

Comments from patients of Winthrop-University Hospital’s Center for the Advanced Care of Chronic Conditions:

“…I can't thank you enough for all your assistance in helping me reach my objective.”

“…I finally feel like I'm getting some answers and am continuing to get better… Knowing I have you guys on my team really makes a difference.”

“…I am extremely happy with the Doctors that you have recommended to me and I am continuing my journey to the new healthier me.”