Historically, there has been a gap in the literature to measure the success and impact of patient navigation programs, but the Standardized Metrics Task Force of the Academy of Oncology Nurse & Patient Navigators (AONN+) recently unveiled a new set of 35 standardized, evidence-based navigation metrics focusing on patient experience, clinical outcomes, and return on investment.
At the 2017 Association of Community Cancer Centers Annual Meeting: CANCERSCAPE, Tricia Strusowski, RN, MS, Manager, Oncology Solutions, LLC, discussed how these metrics can be incorporated into partnerships between oncology patient navigators and physician practices.
Oncology navigators improve patient outcomes by coordinating the care of patients from prediagnosis through survivorship and end of life. According to Ms Strusowski, navigators should introduce the survivorship care plan at the time of diagnosis, along with introductions to palliative care, prehabilitation, goals of care, and advance directives. “We must initiate conversations earlier in the continuum,” she said. “We need to prepare the patient for what’s happening next.”
The AONN+ evidence-based navigation metrics aim to demonstrate the sustainability and validity of navigation programs and are based on the 8 AONN+ certification domains for navigation: Professional Roles and Responsibilities, Patient Advocacy, Psychosocial Support Services Assessment, Care Coordination, Community Outreach and Prevention, Operations Management, Survivorship/End of Life, and Research and Quality Performance Improvement.
For example, the Care Coordination domain encompasses 8 standardized metrics, including treatment compliance (percentage of navigated patients who adhere to institutional treatment pathways per quarter), interventions (number of specific referrals/interventions offered to navigated patients per month), clinical trial education (number of patients educated on clinical trials by the navigator per month), and diagnosis to initial treatment (number of business days from diagnosis [date pathology resulted] to initial treatment modality [date of first treatment]).
“These domains fit beautifully with value-based cancer care,” said Ms Strusowski. Additionally, the metrics can be used by all institutions regardless of their preferred model of navigation, she added.
“After introducing the metrics [at the AONN+ 2016 Annual Meeting], people said, ‘these are great, but we don’t know how to implement them,’” she noted. As a result of this type of feedback, a session on implementing the navigation metrics will be presented at the AONN+ West Coast Regional Meeting, April 27-29, 2017. This presentation will be accompanied by a panel discussion addressing the value of the metrics and the importance of collaborative efforts in moving them forward. Later this year, a Navigation Metrics Repository will be incorporated into the burgeoning navigation literature.
With many oncology practices moving away from the traditional fee-for-service payment model and toward the CMS Oncology Care Model (OCM), patient navigation is gaining even more traction. OCM practices provide enhanced services to Medicare beneficiaries, such as care coordination, navigation, and national treatment guidelines for care, and participating practices must implement 6 practice redesign activities—among them, patient navigation services.
Integration with Physicians
Ms Strusowski stressed the importance of getting all appropriate disciplines involved in navigation efforts as soon as possible. “We have more survivors and fewer physicians,” she said. “We need to support our physicians and find ways to work together.”
Create partnerships and incorporate performance improvement based on navigation and value-based cancer care metrics, she said. Increase efficiency and timely access to services by providing comprehensive assessments and referrals to appropriate disciplines, and reinforce patient education and empowerment through decision aids and patient appointment checklists.
Create standing order sets, physician profiles, pathways, and guidelines, and increase contacts with “frequent flyers” to decrease emergency department visits and avoidable hospital admissions. Additionally, automatic financial counseling referrals should be conducted at the time of diagnosis, since patients often cite more fear of their financial obligations than of the cancer itself, she said.
To help navigators succeed, she encourages the use of a navigator “tip sheet,” including tools such as communication pearls for palliative care discussions, a palliative care fact sheet for patients and their families, clear and jargon-free definitions of common terms, and references/additional resources. Consider drafting an initial palliative care discussion script, as well as a welcome letter to introduce the patient to the navigation team and what they can expect at each point of the care continuum, she advised.
In regard to the rapidly expanding field of navigation, Ms Strusowski said, “we’re trying to make it as foolproof as possible.”