Background: Patient acuity tools have been used to classify patients according to care needs to serve a variety of purposes.1 Several navigation programs have attempted to develop acuity tools to characterize patient data toward the determination of workload distribution,2 but at this time no validated acuity tools exist. In a healthcare environment where navigators are expected to “do more with less,” it is useful to stratify patients according to care needs and assign navigation activities according to those needs. It is also necessary that navigation programs measure their effectiveness through meaningful metrics.3 Psychosocial distress and barriers to care are metrics related to clinical outcomes.4 Navigation-specific patient acuity scores based on barriers and distress may be instrumental in both assigning navigation activities and as clinical outcome metrics.
Objectives: Explore the relationship between acuity scores (based on the number of barriers to care and a patient’s reported distress level) and the reliability of an institutionally developed protocol to sufficiently meet the care needs of acuity-stratified patients as evidenced by decreasing acuity scores. Examine the concept of acuity decreases (resolved barriers, decreased distress) as a metric for navigation-driven clinical outcomes. Does moving a patient from high acuity to low acuity demonstrate effective navigation?
Methods: In the acuity tool selected for this preliminary work, a score is assigned to patients based on where the y axis and the x axis intersect on a graph. The graph has been separated into segments defined as acuity gradations (normal, low, medium, and high). At the initial assessment, the number of barriers to care are plotted on the y axis, and the patient’s reported distress value is plotted on the x axis.5 The resulting acuity score was assigned a predetermined level of navigation activity according to an institutionally developed Barrier and Distress Resolution Protocol. Higher acuity patients received more frequent acuity reassessments to determine if barriers/distress were improving from navigation interventions. Reassessment of barriers and distress have 3 possible acuity outcomes: the acuity score either decreases, increases, or remains the same. Navigators tracked reassessment data as part of their daily routine and reported the acuity change data monthly.
Results: Data collection is ongoing. Acuity changes for 962 patients were tracked in quarterly increments over 6 months in 2018. In the first quarter, 61% of the changes represented a decrease in acuity, 5% represented an increase in acuity, and 63% remained unchanged. In the second quarter, 54% showed a decrease in acuity, 5% showed an increase, and 77% were unchanged.
Conclusion: At this early date, preliminary results show acuity decreases with reassessment of barriers/distress. More data/analysis is needed to determine if the Barrier and Distress Resolution Protocol consistently results in positive clinical outcomes as evidenced by decreased acuity. Similarly, further examination is needed to link decreasing acuity directly to navigation activities aimed at reducing barriers and distress as a metric.
Implications: Using patient acuity scores to assign care protocols may help navigators better prioritize their time. Acuity changes may be another metric to help evaluate effectiveness of navigation activities.
- American Nurses Association. Patient Classification and Acuity Systems. www.nursingworld.org/practice-policy/work-environment/nurse-staffing/workforce-managment-pcas-and-the-rfp-process. Accessed August 2018.
- Blaseg K. Patient navigation at Billings Clinic: an NCI Community Cancers Program (NCCCP) pilot site. www.accc-cancer.org/docs/projects/resources/pdf/patientnavigation-guide/s15.pdf?sfvrsn=875c3b10_0.
- Johnston D, Strusowski T, Sein E. AONN+ national evidence-based oncology navigation metrics quality study: demonstrate value and sustainability of navigation programs. Journal of Oncology Navigation & Survivorship. 2018;9(3):120-122.
- Strusowski T, Stapp J. Patient navigation metrics: measuring the impact of your patient navigation services. Oncology Issues. 2016;31(1):62-69.
- Sullivan-Moore C, Cook C. Patient Navigator Acuity Tool. National Consortium of Breast Centers. http://files.ctctcdn.com/b59f4183201/350b2d96-b1a0-44e9-a585-76207345dbbb.pdf. 2015.