There is a gap in the literature regarding the key areas that measure the success of navigation programs, but a new set of standardized, evidence-based navigation metrics, developed by the Standardized Metrics Task Force of the Academy of Oncology Nurse & Patient Navigators (AONN+), aims to demonstrate the sustainability and validity of navigation programs. The metrics have been in development for the past year and will be published and incorporated into the Joe Biden Cancer Moonshot program as part of an initiative to evaluate and prove the value of patient navigation.
At the AONN+ 7th Annual Navigation & Survivorship Conference, task force team leaders Tricia Strusowski, MS, RN, Manager, Oncology Solutions, LLC; Elaine Sein, RN, BSN, OCN, CBCN, independent navigation consultant; and Danelle Johnston, RN, MSN, OCN, CBCN, Director of Navigation, Sarah Cannon, unveiled 35 new navigation metrics that focus on patient experience, clinical outcomes, and return on investment. The metrics are based on the 8 AONN+ Certification Domains for Navigation, which encompass all of the areas in which navigators practice.
The Institute of Medicine (IOM) recommends that quality care be measured using a core set of metrics. As stated in the IOM report, Ensuring Quality Cancer Care, “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.”
“There are a lot of metrics out there for outreach, surveillance, and diagnosis,” said Ms Johnston. “But with these new navigation metrics we have the opportunity to add to the depth and breadth of metrics related to treatment across the cancer continuum.”
She said the implications for the field of navigation could be transformative. The metrics evaluate professional practice and care delivery and measure the impact of navigation on the realms of quality care delivery, health outcomes, and overall value throughout the cancer care continuum, from diagnosis through survivorship and the end of life. This is necessary for the sustainability of navigation, as it demonstrates the value of navigation programs.
From Idea to Reality
Ms Johnston said the discussion about metrics began at the 2015 AONN+ Annual Conference because of the general consensus that navigators were having trouble demonstrating their value and sustainability and were struggling to measure their programs in regard to outcomes. After gaining approval, a Metrics Project Team was assembled, consisting of members from various disciplines and experts in the 8 AONN+ Domains.
They began with a rigorous review of literature and clinical practice, and spent hundreds of hours focusing on evidence-based studies to support metrics in each domain. “Since these are baseline metrics for navigation programs, we really felt there was an overarching need for them to be feasible, meaningful, and provide the breadth and depth that all programs need as they evaluate their navigation programs,” said Ms Sein.
They hosted a Standardized Metrics Retreat earlier this year, during which the team identified and finalized these 35 new standard metrics for navigation after putting every single metric through an exhaustive review to confirm its accuracy, legitimacy, and usability for all types of navigation programs. “We could have come up with 150 metrics from 300 articles, but the idea was to do something useable that people in all programs—clinical, community, etc—could use,” she said, noting that the metrics are at a starting point and will be embellished moving forward.
From there, the task torce aimed to present the new metrics at the 2016 AONN+ Annual Conference, so they could be put into the hands of practicing navigators as soon as possible, and they achieved that goal despite the very limited time frame.
Each of the 8 AONN+ Certification Domains—Professional Roles and Responsibilities, Patient Advocacy, Psychosocial Support Assessment, Care Coordination, Community Outreach, Operations Management, Survivorship/End of Life, and Research and Quality Performance Improvement—is now described and accompanied by a list of its corresponding metrics. For example, the domain of Psychosocial Support Assessment relates to distress screening, strategies for coping (ie, disease, treatment, distress/anxiety), and referrals to psychosocial support, and the metrics for this domain are:
- Psychosocial Distress Screening: defined as the number of navigated patients per month who received psychosocial distress screening at a pivotal medical visit with a validated tool. A pivotal medical visit is defined as a period of high distress for the patient when psychosocial assessment should be completed. Various validated tools are defined as follows: FACT, National Comprehensive Cancer Network Psychosocial Distress Screening Thermometer.
- Social Support Referrals: defined as the number of navigated patients referred to a support network per month.
The AONN+ Standardized Metrics Task Force succeeded in establishing baseline metrics that all institutions can use, regardless of the structure of the navigation. According to Ms Sein, “the detail that went into this to prove we were working in a rigorous and valid way cannot be overstated.”
Ms Strusowski called the unveiling of the metrics “unbelievably exciting” and noted that as disease-specific certification evolves, additional evidence-based disease-specific metrics will need to be developed to dovetail into the standardized navigation metrics.