Pre-Conference: The Navigator Matrix
3 likes2,966 views
This document outlines a navigation matrix that provides a framework for standardizing and assessing cancer patient navigation programs. The matrix covers key areas like stakeholders, community partnerships, risk factors, metrics, marketing, navigator responsibilities, clinical trials involvement, and disparities focus. It also provides an example application of the matrix to the navigation program at Billings Clinic, describing their program evolution and how they meet various areas of the matrix. The overall goal of the matrix is to help cancer centers standardize, evaluate, and advance their navigation programs over time.
Pre-Conference: The Navigator Matrix
- 1. The Navigator MatrixKarylBlaseg, RN, MSN, OCNBillings Clinic Cancer CenterTricia Strusowski, MS, RNHelen F. Graham Cancer CenterJay R. Swanson, RN, BSN, OCNSaint Elizabeth Cancer Institute
- 2. ObjectivesUnderstand the purpose of standardizing a navigation programBuild metrics to establish the benefit of a navigation programEngage in assessing a navigation programAnalyze matrix levels to determine areas of opportunity for advancement of program
- 3. BackgroundSomeone very wise once said:IF you have seen one navigation program,You have seen one navigation program.- Tricia Strusowski
- 4. PurposeCase management modelStandardizationCommission on Cancer (CoC) standardsProvide the basic building blocks for navigation programs
- 6. Key StakeholdersThose people that you feel are essential to making a program work, including administration, navigators, staff, physicians (both employed and private practice). Specialty areas include medical, surgical and radiation oncology, rehabilitation, palliative care, and hospice
- 7. Community PartnershipsThose entities that exist within and outside of your program that you need the support of or are a referral source for patient use and contribute to the support of the patient along the continuum of care
- 8. Acuity System/Risk FactorsAbility to determine appropriate level of care/intervention based on patient need and disease processVariable associations with increased risk of complications with disease and treatment of cancer
- 9. Metrics/Reporting MeasuresMeasuring activities and performance
- 10. Marketing of the Navigation ProgramHow do you get the message out about your program?What programs outside of navigation are in place that you can partner with?
- 11. Percentage of Patients Offered NavigationBased on analytic totals or other metricOf course you would assume all patients are offered navigation, but may not be that easy
- 12. Continuum of NavigationNavigation functional areas include: outreach/screening, abnormal finding to diagnosis, treatment, outpatient and/or inpatient, survivorship, and end-of-life care. Navigation can occur along any or all of these. One single person may do all of these, or you may have one person designated to cover one area of the continuum. They may be disease-specific navigators, or cover all diseases within that category. The sign of a level 5 site is that navigation is continuous across the cancer care continuum.
- 13. Support Services Available and Used by the Navigation Team
- 14. Tools for Reporting Navigator StatisticsDocuments to help evaluate and measure a navigation program
- 15. Financial AssessmentThe expense not only for medical care and treatment but the additional costs associated with the effects on life change are dramatic Financial assessment therefore is as important as the physical assessment
- 16. Focus on DisparitiesIs any underrepresented group that your program is able to focus on. Providing outreach and effort in this population is a hallmark of navigation according to its original conception and should be continued as part of a navigation program
- 17. Navigator ResponsibilitiesAs a program grows, navigators start to take on different roles, while maintaining a central core responsibility of patient assistance
- 18. Patient Identification ProcessNavigators have to find a way to interact with their patients
- 19. Navigator TrainingSome form of training must be given to the navigators to ensure a high quality of care and commitment of the navigation program
- 20. Engagement with Clinical TrialsWith Clinical Trials being a major part of the advancement of cancer care, it is important that navigation work with clinical trials departments to offer patients the best possible care
- 21. Multidisciplinary CareMultidisciplinary team approach to care including physicians (medical oncology, radiation oncology, and surgeon) and other healthcare providers to create plan of care for patient; patient may not always be present to be considered MDC
- 22. Application of the Navigation Matrix to Patient Navigation at Billings Clinic
- 23. About Billings Clinic…Nonprofit, community governedMultispecialty group practice300-bed hospital, cancer center, surgery center, research center, retirement communityPrimary and specialty care clinics Service area = 207,000 sq miles2010 cancer registry stats1470 new analytical cases1635 new total casesNavigation program established in 2003
- 24. The Role of the Care NavigatorTo ensure the best cancer care experience through coordination of services
- 26. Key StakeholdersReferrals received from our employed primary care and specialty providers, as well as from regional providers and state screening program
- 27. Community PartnershipsStrong connections with:American Cancer SocietySusan G. Komen for the CureMontana Cancer Control CoalitionLIVESTRONG
- 28. Acuity System/Risk FactorsNavigation points Initial referral/ consult appointmentsStart of treatmentRestaging (imaging)Change in treatment/new treatmentEnd of treatment
- 29. Quality ImprovementPatient satisfaction surveysTimeliness of careMultidisciplinary clinic quality metrics
- 30. Marketing of the Navigation ProgramBrochure/insert cardWebsiteBillboardsVideoNews stories
- 31. Percentage of Patients Navigated2010 registry: 1470 analytic; 1635 all2010 patients navigated: 803
- 32. End of LifeNavigation Continuum Survivorship Treatment DiagnosisPrevention & Early DetectionCARE NAVIGATION
- 33. Support ServicesSocial workers, licensed counselorsFinancial counselorsGenetic counselorDietitianPsychiatric nurse practitionerPhysical therapist, lymphedema specialist, massage therapistsSymptom management teamPastoral care
- 34. Tools for ReportingPatient database (Excel)Key information utilized for program metricsData summarized and reported quarterly to multidisciplinary teams
- 35. Financial AssessmentFinancial counselors assigned to the cancer centerAutoreferral built into computerized physician order entry, but referrals also initiated by navigator, physician, social worker, pharmacist, nurse, etcPreauthorization of all treatments
- 36. Focus on DisparitiesUnderserved populationRural and American Indians22 outreach clinics per monthTelemedicine technologyRepresentation on advisory boardsNumerous outreach activitiesCultural sensitivity training for staff and providers; also offered throughout the regionCollaboration with American Indian organizations
- 37. Navigator ResponsibilitiesProviding guidance through the system Initiating referrals to MDC and case conferenceCoordinating appointments Providing education Connecting patient to resources for insurance, financial, and social concerns, as well as to supportive servicesCo-chairing multidisciplinary program meetings Tracking metrics for MDC outcomesFacilitating support groups and/or educational offeringsAssisting with community outreach events
- 38. Patient IdentificationReferrals received from primary care and specialty physicians, as well as nursing and ancillary staffNew appointment type scheduled in the cancer center triggers a printout to the navigator office Technical assistance previews clinic schedules
- 39. Navigator TrainingOrientation by lead navigatorInitial competenciesAnnual competenciesAttendance at case conferencesQuarterly navigation retreats with educationPRN training/in-servicesOnline training for site-specific cancer careSupport to attend national conferencesSpecialty certification
- 40. Clinical TrialsNCI clinical trials educationAwareness of trials available Referral of patients to research coordinatorsPartnership with research coordinators
- 41. MDC InvolvementReferral comes to navigatorPre-visit work-up needs determinedAppointments coordinated with MDC teamNavigator attends each MDC appointmentPatient is presented at next case conference Preliminary plan document is completed and sent to patient, as well as referring MD
- 42. CoC Standard 3.1 (drafted)The cancer committee conducts an assessment of barriers to care for patients with cancer. A patient navigation process is established to address barriers to care for patients with cancer and healthcare disparities either on site or by referral. The cancer committee evaluates and reports on the process annually.
- 43. CoC Standard 3.1 (drafted)Criteria to meet drafted standardNeeds assessment conducted to guide navigation servicesNavigation services provided on site or by referral to address healthcare system barriers Cancer committee evaluates the navigation process annually
- 44. Advancing Your ProgramOpen discussionWhat creative ideas do you have about advancing your navigation program?Do you have concerns or barriers regarding advancing your program in any of the categories?Other thoughts?
- 45. Wrap-up/Lessons LearnedMany cancer centers require direction when initiating a new navigation program
- 46. Once navigation program is developed, many sites need assistance with next steps
- 47. Cancer centers need to constantly assess and develop new goals for their program…keep it fresh
- 48. Include your physician champions and other key stakeholders when assessing the program
- 49. Utilize matrix to assist with PI initiativesQuestions?
- 50. ReferencesThe Advisory Board Company: Patient Navigation 2008-17647.ADAHPT Case Management Model. www.health.nsm.gov.au/resources/adahps/pdf/case_mgt_model.pdf. 2011.Blaseg K. Patient Navigation at Billings Clinic: An NCI Community Cancer Centers Program (NCCCP) Pilot Site. ACCC’s Cancer Care Patient Navigation: A Call to Action. 2009:15-24.Campbell C, Craig J, Eggert J, Bailey-Dorton C. Implementing and measuring the impact of patient navigation at a Comprehensive Cancer Center. Oncol Nurs Forum. 2010;31(1):61-68.Centers for Disease Control and Prevention. Health disparities in cancer. www.cdc.gov/Features/CancerHealthDisparities. 2011.Commission on Cancer: 2009 Standard 2.7.Dohan D, Schrag D. Using navigators to improve care of underserved patients. Cancer. 2005;104:848-855.Freun KM, Gattaglia TA, Calhoun E, et al. National Cancer Institute Patient Navigation Research Program: methods, protocol and measures. Cancer. 2008;113:3391-3399.Gilbert JE, Green E, Lankshear S, Hughes E, Burkoski B, Sawka C. Nurses as patient navigators in cancer diagnosis: review, consultation, and model design. Eur J Cancer Care. 2011;20:228-236.
- 51. References (cont.)Harold P. Freeman Institute for Patient Navigation. Harold P. Freeman Patient Navigation Program/Model, Patient Navigation. 2011.Koh C, Nelson JM, Cook PF. Evaluation of a patient navigation program. Clin J OncolNurs. 2011;15(1):41-48.Koutnik-Fotopoulos E. Implementing and growing a navigation program. J OncolNavig Survivor. 2010;1:6-7.Case Management Society of America. http://cmsa.orgau/definition.html.NCCCP Disparities Subcommittee White Paper, 2010. http://ncccp-intra.nci.nih.gov/programs/Disparities% 20White%20Paper%20draft%2008%202010.pdf.National Institutes of Health. NIH Publication No. 10-7605.Peersen A, Hack T. Pilots of oncology health care: a concept analysis of the patient navigator role. OncolNurs Forum. 2010;37:55-60.Schafer J, Swisher J. Cancer Care Coordination with Nurse Navigators. Sg2 Health Care Intelligence. 2006.Schwaderer KA, Itano JK. Bridging the healthcare divide with patient navigation: development of a research program to address disparities. Clin J OncolNurs. 2007;11(5):633-639.Swanson JR, Koch LM. The role of the oncology nurse navigator in distress management of adult inpatients with cancer: a retrospective study. OncolNurs Forum. 2010;37(1):69-76.Wells KJ, Battaglia TA, Dudley DJ, et al. Patient navigation: state of the art or is it science? Cancer. 2008;113:1990-2010.