Although there historically has been a gap in the literature regarding the key areas that measure the success of navigation programs, the Academy of Oncology Nurse & Patient Navigators (AONN+) evidence-based oncology navigation metrics are making strides in closing that gap. The 35 quality metrics, which were announced at the AONN+ 7th Annual Navigation & Survivorship Conference in 2016, aim to demonstrate the sustainability and validity of navigation programs by measuring patient experience, clinical outcomes, and return on investment.
In 2017, at the AONN+ 8th Annual Navigation & Survivorship Conference, members of the Standardized Metrics Task Force announced plans for a navigation metrics pilot study that includes a new metrics repository and database and discussed the ways in which navigators fit into the value-based cancer care landscape.
“As evidence guides practice, it is essential for navigation programs to identify core metrics and to standardize data collection, so we can clearly demonstrate program outcomes,” said Elaine Sein, RN, BSN, CBCN, independent navigation consultant. “We are finally able to compare apples to apples with our metrics; comparisons between outcomes are not relevant if you’re not using standardized data elements, and now we have them.”
Phase 2: The Navigation Metrics Database and Repository
Since the announcement of the metrics, numerous national organizations have expressed interest in partnering with AONN+ to support value-based cancer care, according to Danelle Johnston, RN, MSN, ONN-CG, OCN, CBCN, Chief Nursing Officer and Senior Director of Strategic Planning and Initiatives at The Lynx Group. “We’re really excited about the national momentum taking place around these metrics,” she said.
The goals of the navigation metrics research study include developing the quantitative data necessary to set nationally recognized and validated benchmarks (applicable to any type of navigator and any institution across the entire care continuum regardless of their model of navigation); delivering meaningful outcomes that will provide the needed elements to support the value of navigation; demonstrating the impact of those outcomes on quality cancer care delivery, return on investment, patient experience, and program sustainability; and integrating performance improvement methodologies and data analytics to drive quality outcomes and establish pathways for reimbursement.
Of the 35 navigation metrics, the task force chose 6 key metrics for the pilot study: Clinical Trial Education, Diagnosis to Initial Treatment, Navigation Caseload, Emergency Room Utilization, Psychosocial Distress Screening, and Survivorship Care Plan. All of the metrics—and these 6 in particular—dovetail nicely with the Oncology Care Model (OCM), the Commission on Cancer (CoC), the National Accreditation Program for Breast Centers (NAPBC), the Quality Oncology Practice Initiative (QOPI), and the Merit-Based Incentive Payment System (MIPS) national standards and accreditations, noted Ms Johnston.
“When you start looking at our metrics and how it crosswalks with the CoC, NAPBC, QOPI, OCM, and MIPS, this is some powerful stuff,” added Tricia Strusowski, RN, MS, Manager at Oncology Solutions, Inc. “The synergy is ridiculous.” In its pilot study, AONN+ aims to include 2 National Cancer Institute–designated academic medical centers, 2 CoC-accredited community-based cancer programs, 2 freestanding physician practices that participate in the OCM, and 2 basic cancer programs that have no metrics or reports in place. The pilot sites have not yet been selected.
The Right Place at the Right Time
According to Ms Strusowski, creating national standards attracts members of the healthcare community to participate in this initiative in collaboration with AONN+ to support continuous quality improvement and value. “We know once we get this database going, our work will really get started,” she said. “We’re going to have to look at this continuously to ensure great outcomes.”
National standards also identify best practice programs that elevate cancer care on a grander scale, drive quality outcomes, and establish consensus-driven standardized care delivery measures and models. “Our goal with this database and repository is to support the navigators. We want you to look at some of those metrics you don’t necessarily want to look at,” she said. “But we want to raise the bar when it comes to navigation. We want to collect some very valuable outcomes.”
“Why is this so important?” she asked. “Because if we have 5 navigators, we have 5 definitions of navigation.” But the database will require uniform data acquisition, conversion, validation, and visualization. “We have to be able to visualize what it’s going to give back to us in regard to reports we can provide to our cancer committee, our administrators, and our providers.”
According to Ms Strusowski, harnessing the power of the navigation metrics will leverage AONN+ for its next steps by using data—for the first time—to show the impact of navigation. The organization is well positioned to capitalize on a pioneering opportunity to improve health system program efficiencies and plant the flag as a leading authority for oncology navigation and survivorship initiatives. This momentum could even support the continuation and expansion of oncology navigation programs and services. “This is groundbreaking. Nobody else out there is doing this for navigation. We are it,” she said. “When we say people are paying attention to us, they are. We know how important this is, but when we have other people looking to us as leaders, that’s power.”
“We are in the right place at the right time. I can’t believe that a year ago we were presenting the metrics, and now we’re creating this database and repository,” she continued. “This is absolutely critical to next steps for AONN+. We don’t know what we’re going to uncover with this database, which is so very exciting. I think the doors that are going to open will blow our minds.”