Cohort Management and Health Network

By Deliana Garcia, MA, Director of International Projects, Research, and Development, Migrant Clinicians Network

Migrant Clinicians Network recently collaborated in a university-sponsored TB screening to determine the effectiveness of using Health Network to manage a cohort of migrant research subjects.  Health Network, a program of Migrant Clinicians Network, is a system for virtual bridge case management and patient navigation. 

Few studies include migrant research subjects due to researchers’ concerns with follow-up with migrants.  For a recent TB infection screening at the University of Arizona, Migrant Clinicians Network contracted with the University of Arizona to provide follow-up services, including database management, tracking, and phone calls, to a cohort of individuals tested for TB Infection utilizing the Health Network system. Health Network fulfilled the study’s goal of providing patient navigation to treatment services and case management to any participant for whom treatment was initiated. After a brief training of the study team, it was agreed that those recruited for TB testing would be directed to a Health Network Associate via telephone to be enrolled in the case management program on the day of testing. Additionally, individuals in the study who initiated treatment because of a discordance between skin testing and Quantiferon results (negative/positive) or concordance of positive results were passed to Health Network associates for follow-up services to assure treatment was maintained. 

On the day of the screening, 18 patients were interviewed by a student member of the research team. They were then directed to Health Network via telephone and a Health Network case file was initiated for each one. Every subject was assigned to a Health Network Associate as a part of the Associate’s follow-up case load. The Associates contacted or attempted to contact each of the subjects to provide him/her with testing outcome information. 

During the course of the study, the researchers identified several issues of concern:: 

• Poor cell phone signal impeded Health Network Associates’ ability to complete enrollment;
• Addition of an extra step into the testing day procedure added significantly to the time that the subjects were required to remain at the site
• Asking inexperienced students to enroll participants in Health Network slowed the process;
• Limited time to explain to the subjects the benefits and limitations of enrollment in Health Network potentially reduced participation and created unrealistic expectations. 

Of the 18 test subjects:

• Five subjects did not return to receive skin test results – all but one of these subjects has been contacted by Health Network.
• Reports were not received by Health Network at the time of enrollment for two of the subjects.
• Phone numbers were not obtained for two subjects rendering it impossible to follow up with them.
• Communication has been maintained with nine of the subjects.
• Four of the subjects expressed an interest in additional participation.
• One subject requested assistance with a non-TB related health care concern.

Due to the limited size of the cohort, other efforts to demonstrate the effectiveness of using Health Network to manage a cohort of migrant research subjects are required. However, the continuing success in communicating with the participants gives strong support to the belief that migration does not limit participation in research that can aid significantly in the understanding of the health concerns of migrants and the development of effective interventions.