Objective: To develop a nurse navigation (NN) program within an academic, multisite community-based cancer institute and implement standardized NN practices to ensure oncology patients receive consistent, high-quality NN support regardless of where they live. Uniform documentation and data capture methods were developed and leveraged to benchmark performance and evaluate the effect of standardized NN on improving clinical cancer outcomes.
Methods: Between 2013 and 2015, standardized processes were implemented to guide NN practice across the Levine Cancer Institute (LCI) network. LCI administrators rewrote the navigator job description, developed a standardized intake process, an acuity grading system, and defined their NN process. With LCI Information Services, 2 tools were developed: 1) an electronic form integrated within the EMR to capture data and facilitate abstraction for reporting and research; and 2) a tracking tool allowing NN to define patient cohorts and observe patient appointments, hospital admissions, and no-shows in near real time and in 1 place. After program implementation, we conducted 2 retrospective quasi-experimental studies to assess 30-day hospital readmissions and 12-month overall survival between patients who did and did not receive NN. NN has been shown to reduce unmet health needs and improve treatment compliance, which can impact clinical outcomes. Propensity score matching was used to match navigated to similar not navigated patients. Logistic and Cox regression were used to analyze the effect of NN on readmissions and survival, respectively.
Results: There are 24 navigators across LCI and over 11,000 patients in the tracking system. In study 1, 4324 matched patients (2162 navigated/not navigated) were included. Seventeen percent of navigated and 21% of not navigated patients were readmitted within 30 days. In multivariable analysis, navigated patients had lower odds of readmission (OR = 0.66; 95% CI, 0.48-0.92; presented at 2016 American Society of Preventive Oncology meeting1). In study 2, 776 matched (388 navigated/not navigated) patients diagnosed with a diverse set of 8 cancer types (AML, esophagus, liver, lung, myeloma, ovary, pancreas, stomach) were included. Patients who were not navigated had a higher rate of death and shorter median survival 12 months postdiagnosis (HR = 2.16; 95% CI, 1.72-2.71; presented at 2016 American Society of Clinical Oncology meeting2).
Conclusion: A standardized, integrated NN program demonstrated significant improvements in 30-day readmissions and 12-month survival in navigated versus not navigated patients. Additional research is needed to confirm long-term effects in this cohort and in future multicenter effectiveness trials.
References
- Kowalkowski MA, Raghavan D, Blackley K, et al. Patient navigation associated with decreased 30-day all-cause readmission. Cancer Epidemiol Biomarkers Prev. 2016;25:558.
- Kowalkowski M, Raghavan D, Blackley K, et al. 12 month survival for oncology patients with versus without patient navigation. J Clin Oncol. 2016;34(suppl). Abstract 6510.
