Although those most familiar with navigation would never doubt its value, the current climate of value-driven healthcare demands the demonstration of quality and outcomes. Recognizing this, AONN+ leaders undertook the task of creating, researching, and guiding the implementation of evidence-based navigation metrics.
“We believe the navigation metrics will really be transformative to cancer care,” said Monica Dean, HON-OPN-CG, AONN+ Director of Patient Navigation Program Development, who led the session alongside Danelle Johnston, MSN, RN, HON-ONN-CG, OCN, and Tricia Strusowski, MS, RN.
In 2017, AONN+ identified 35 evidence-based navigation metrics that were most relevant to oncology care, based on patient experience, clinical outcomes, and return on investment. The following year, the Academy partnered with the American Cancer Society and Chartis Oncology Solutions to conduct a multisite national research study on the metrics in action. The efforts have culminated in 2020 with the completion of the AONN+ Navigation Metrics Toolkit, which is aimed at helping navigators, oncology program administrators, healthcare executives, and other clinicians involved in navigation to understand, support, and implement the integration of standardized metrics into their normal business processes.
“This toolkit has been a labor of love for all of us and we’re just so excited to share this with you,” Ms Dean said. “I think the toolkit is going to provide some great guidance and great examples for navigation programs.”
Of the 35 metrics first identified, members of the Metrics Committee chose 10 to include in the research study. After reviewing the study results, these were whittled down to 5 core metrics found to have the greatest impact on oncology navigation and deemed likely to be universally applicable. These are:
- Navigator competencies
- Navigation caseload
- Barriers to care
- Psychosocial distress screening
“They’re baseline metrics that all institutions can use, regardless of the model of navigation,” Ms Johnston said.
Collecting metrics data can seem like yet another burden on the shoulders of navigators, but in reality, the demonstration of value is an overall asset to navigation programs.
“This is part of our role as navigators, and it needs to be reflected in our job descriptions and role delineations,” Ms Strusowski said. “You are in a very unique position in the healthcare team to help do healthcare transformation and that’s why metrics are so important, because they help you tell your story.”
Limitations to qualitative data collection pose an issue. Because data primarily come from site leads and navigators, they can overemphasize the navigator’s perspective, without taking into account other relevant perspectives. As a result, findings may underestimate barriers for metrics data that are not collected directly by navigators. In addition, variations in responses can create bias, as sites differed in their willingness to provide candid feedback. With this in mind, the analysis focused on facilitators and barriers to data collection identified at multiple sites, instead of making cross-site comparisons, according to Ms Strusowski.
Facilitators to data collection include aligning the process with existing workflows, creating a unified template to capture metrics, using discrete reporting fields, and gathering support from IT, clerical/administrative teams, and the study team, she said.
Perhaps most important to demonstrating value through metrics is garnering the support of key stakeholders within an institution or health system. Finding a physician champion to support the metrics measurement process is a great first step, as is eliciting buy-in from others in leadership positions, Ms Johnston said. Other key stakeholders with whom to seek engagement include IT directors and electronic health record providers, social workers, health psychologists, tumor registry representatives, case managers, clinical trial representatives, performance improvement/quality representatives, patient/family caregivers, and billing staff. Navigators can work with these stakeholders to determine which metrics are best for their programs. It is best to include metrics that fit with existing program goals, as well as ones that incorporate data being collected or reported elsewhere.
“When these metrics aligned with preexisting workflows, it was much more natural for the navigators,” Ms Strusowski said.
As data are gleaned and analyzed, it is important to compile it in a simple, digestible format. That is where the navigation metrics dashboard comes in, Ms Strusowski said. By creating a dashboard, programs can convey data so it can easily be shared with program directors and administrators.
For further information on the AONN+ navigation metrics, visit aonnonline.org/navigation-metrics. The AONN+ Navigation Metrics Toolkit can be found at aonnonline.org/images/resources/navigation_tools/2020-AONN-Navigation-Metrics-Toolkit.pdf.