PROJECT SUMMARY/ABSTRACT
This is an application for a K01 award for Dr. Mark Fleming, a medical anthropologist at the University
of California, Berkeley (UCB). Dr. Fleming is establishing himself as an investigator focused on health system
interventions to address social determinants of health for vulnerable populations. For this K01 award, Dr.
Fleming proposes a novel mixed-methods study of patient navigation (PN) for emergency department (ED)
high utilizers. ED high utilizers typically have multiple chronic illnesses and significant unmet social and
behavioral health needs. PN is a promising intervention for health systems to address this combination of
medical, social and behavioral health needs for high utilizers, but its effectiveness is poorly understood. Dr.
Fleming will conduct a mixed-methods evaluation of an ED PN program implemented at the University of
California, San Francisco (UCSF). He will determine the effect of ED PN on subsequent medical, social
services and behavioral health utilization using an existing composite database (Aim 1). This will be the first
study to measure whether ED PN for high utilizers actually changes utilization of social and behavioral health
services situated outside of the medical system (including housing services, income support, and mental health
and substance use treatment). This will enable Dr. Fleming to test the hypothesis that linkage to and use of
these services mediates the effect of ED PN on subsequent reductions of acute care utilization. Dr. Fleming
then will conduct a qualitative study to identify the tasks and processes that constitute “navigation” and explain
how ED-based PN works to achieve its effects (Aim 2). Finally, Dr. Fleming will use stakeholder-engaged,
design engineering methods to develop an evidence-based, optimized PN program for high utilizers (Aim 3)
and will subsequently propose an R01 to implement and evaluate the optimized intervention.
This K01 award will provide Dr. Fleming with the support and research experience necessary to build
on his training in medical anthropology and develop a mixed-methods research program in health services. To
achieve this goal, this award will provide targeted training the following areas: 1) quantitative methods for
health services research, 2) implementation science, and 3) professional development to become an
independent health services investigator. Dr. Fleming’s training plan includes formal coursework, individual
tutorials from his multi-disciplinary mentorship team, and participation in health services research and
evaluation groups. Dr. Fleming has assembled a mentoring team comprised of primary mentor, Dr. Steven
Shortell, national leader in health systems research and Director of the joint UCB-UCSF health services
training program (AHRQ-T32), Dr. Urmimala Sarkar, expert in implementation science and innovative design
methods for health services interventions, Dr. Nancy Burke, expert in mixed methods research in health
systems, Dr. Maria Raven, Medical Director of UCSF ED PN program and expert in emergency medicine
health services research, and Dr. Laura Gottlieb, national leader in health system social needs interventions.