Project Team: Sharon Gentry, RN, MSN, CBCN; Elizabeth Brown, MHA, OCN; Nicole Messier, RN, BSN; Barbara McHale, RN, BS, OCN, CBCN; Cheryl Bellomo, RN, BSN, OCN; Linda Bily, MA, CSA; Vanessa Rodriguez, MSW
Background: There is a gap in the literature regarding the key areas that measure the success of navigation programs: patient experience (PE), clinical outcomes (CO), and business performance or return on investment (ROI) metrics that will demonstrate the sustainability of navigation programs. In the report published by the Institute of Medicine, Ensuring Quality Cancer Care, the recommendation is that quality care is measured using a core set of metrics: “To ensure the rapid translation of research into practice, a mechanism is needed to quickly identify the results of research with quality-of-care implications and ensure that it is applied in monitoring quality.”1
Objective: To develop standard metrics in the area of PE, CO, and ROI using the AONN+ DOMAINS for certification. These domains contain a comprehensive list of all areas in which navigators practice to provide quality patient care and financial stability for their organizations.
Methods: The project team leaders developed a project proposal that was submitted to AONN+ executive leadership for approval and support to fund this initiative. AONN+ leadership accepted the proposal, and a project team of content experts was organized. This team was formed to create standard metrics in the 3 identified areas focused on PE, CO, and ROI using the AONN+ DOMAINS. A WebEx was held to roll out the project, time lines, and expectations of each team member and to outline the preparation required prior to retreat. A literature review was completed by each member in whom they had validated expertise in assigned domain. Each member used measure development criteria ensuring feasibility, meaningfulness, and breadth of metric to ensure reliability and validity. A 1-day retreat was held with the taskforce members to review metrics for each domain, literature support, and benchmark, and finalized a set of standard metrics. Then, using a Likert scale, ranked the metrics to determine which met rigorous review and were acknowledged as high validity that all navigation programs can utilize.
Results: The taskforce developed standardized metrics that focused on the AONN+ certification domains for navigation that concentrated on ROI, PE, and CO. After the completion of an extensive literature review, and after putting each metric through rigorous criteria to ensure accuracy and soundness of each, 35 metrics were developed.
Conclusions: The 35 developed metrics are baseline metrics that all navigation programs, no matter their structure, should be evaluating and monitoring. The taskforce recognizes that navigation programs are developing at different rates within diverse structural organizations and settings that will determine which standardized metrics will be essential to measure outcomes for their specific navigation program. As disease-specific certification evolves, additional evidence-based disease-specific metrics will need to be developed to dovetail into the standardized navigation metrics.
- Hewitt M, Simone V, eds. Ensuring Quality Cancer Care. Washington, DC: National Academics Press; 1999.