Managing a Navigation Program: The Role of Administrators
Upcoming SlideShare
Loading in...5
×
 

Managing a Navigation Program: The Role of Administrators

on

  • 3,136 views

Phyllis A. DeAntonio, RN, MSN, FAAMA

Phyllis A. DeAntonio, RN, MSN, FAAMA
Marie S. DeStefano, RN, MSN, FAAMA

Statistics

Views

Total Views
3,136
Views on SlideShare
3,035
Embed Views
101

Actions

Likes
0
Downloads
38
Comments
0

2 Embeds 101

http://www.aonnonline.org 89
http://aonnonline.org 12

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • Good morning everyone! I am so happy to be here, of course you know I did have to turn down an invitation to the Royal Wedding But really, I am excited to share my program with you, It is my first time presenting at Congress, I am a bit nervous, but figure I am talking about what I do everyday so as long as I don’t fall down I’ll be ok And hey someone out there will revive me Right?
  • Reference http://action.lls.org/atf/cf/%7B28668E32-EB72-4C5E-B1D6-BE5E9E58E6C9%7D/Patient_Navigation_Funding.doc and GovTrack.us. H.R. 1812--109th Congress (2005): Patient Navigator Outreach and Chronic Disease Prevention Act of 2005, GovTrack.us (database of federal legislation) (accessed Nov 25, 2007)
  • Reference http://action.lls.org/atf/cf/%7B28668E32-EB72-4C5E-B1D6-BE5E9E58E6C9%7D/Patient_Navigation_Funding.doc and GovTrack.us. H.R. 1812--109th Congress (2005): Patient Navigator Outreach and Chronic Disease Prevention Act of 2005, GovTrack.us (database of federal legislation) (accessed Nov 25, 2007)
  • Great As we may have heard about The American College of Surgeons, Commission on Cancer will be requiring a Patient Navigation Program for accreditation
  • We are so fortunate to have our interdisciplinary team all on site to help expedite and coordinate care
  • Comment I see most of you have Breast navigation programs, Which is where I am, I am lucky to have a captive audience , working with individuals who have breast abnormalities on imaging is when i first interact with patients I know it is more difficult to establish this point of contact for other sites
  • Now my role is comfortable, but it didn’t start off that way. It was a new concept and I had to really sell myself and service. Mentorship from my sister hospital DCMH was helpful as well as all the support I received from the Fox Chase Cancer Center Partnership Breast Care Coordinator Team, I found quickly that navigation programs vary from institution to institution, even within Health care Systems. ,
  • I am going to start by introducing you to the Health System in which I work and the history of the Navigation program there Crozer Keystone Health System has 5 hospitals in Delaware County Pa, just south of Philadelphia Pt navigation really started there before the buzz word took off. We have had a nurse in the system who navigated our breast and cervical patients through the CDC’s Healthily Woman Program in which provides breast and cervical screenings to the uninsured in PA. She has been also managing the Granted monies from Komen for the Cure for our system which we have been lucky enough to receive over 1 million dollars to care for our Ladies in Delaware County. The official role of Breast naviagator was established in 2005 and proved by the reduction in out patient migration of breast health patients to be successful. Along with that there were other benefits such as timiness to care patient and physician satisfaction. The role was established at Crozer in 2006 , and I have been there from the start, and can honestly say everyday is something new!
  • So I found great mentorship and my Champion if you will in Women’s Imaging. I learned so much from our Breast Imagers and technicians This is where I became an important part of other Breast Health Tem
  • So I found great mentorship and my Champion if you will in Women’s Imaging. I learned so much from our Breast Imagers and technicians This is where I became an important part of other Breast Health Tem
  • So Pt navigation starts at time of abnormal imaging. We are a busy center with designated diagnostic and biopsy days I also get referrals through our web site , Hope line or word of mouth.
  • Our algorithm looks like this This is where the patients may have the most stress, at time of abnormal imaging and waiting for biopsy results.
  • Our multidisciplinary team meets weekly and cases are presented prospectively throughout patient care planning. Ans in follow up as needed Clinical Staging, course of care and barriers are identified and discussed. Patents are notified of any changes in care that may have evolved from conference.
  • So in evaluating our Navigation program, The focus has been on out migration Be so close to renowned University Hospitals is tempting for patients and prior to my position out migration was high Capturing data is straight forward These are monthly stats that are reported to administrator Additional Metrics are also kept in regards to timeliness and treatment modalities
  • So now out migration looks like this Prior to navigation Program we were losing 14% of our breast patient to other institutions, Now , just 2%
  • So yea we think so , keeping this percentage of our newly dx breast cancer patients makes everyone happy Especially Administration
  • Becayou can see the return on investment is huge- Keeping just one extra patient in the system, requiring all the different services provides revenue for the hospital
  • Of course there are other benefits as well Such as patient and physician satisfaction,…..
  • So in ending, if just starting your program , evaluating your program or in the mist of changing your program Remember to g slow and take a team approach so that you can have success And one more thing Congratulations to Will and Kate!! Thank you for your attention!

Managing a Navigation Program: The Role of Administrators Managing a Navigation Program: The Role of Administrators Presentation Transcript

  • Managing a Navigation Program: The Role of Administrators Phyllis A. DeAntonio, RN, MSN, FAAMA Administrator, Cancer Services Pitt County Memorial Hospital University Health Systems of Eastern North Carolina Greenville, NC
  • Objectives
    • Create strategies for the identification and removal of specific barriers to efficient and effective patient care.
    • Discuss the roles of various types of navigators and the ways in which they improve patient care.
    • Evaluate best practices regarding patient navigation and survivorship care.
    • Understand the processes for implementing and sustaining a successful survivorship program.
    • Assess methods for managing the psychosocial needs of patients and caregivers.
  • Burden of Cancer
    • 2011 U.S. Incidence – 1,596,670 new cases; Deaths - 571,950
    • 2011 N.C. Incidence – 48,870 new cases; Deaths - 19,760
    • US Cancer Survivorship – over 12 million
    • NC Cancer Survivorship – 362,810
  • Teaching Hospital Cancer Program Accredited by ACoS CoC Teaching Hospital Cancer Program Accredited by ACoS CoC
  • Role of Nurse Navigator
    • “ To provide continuity of care for cancer patients across the continuum. The navigator will be an active member of the cancer care team and provide support as needed.”
  • Article from Community Focus
  • Responsibilities of Nurse Navigator
    •  
    • Meets the patient/family at the point of a suspicious finding
    • Identifies any barriers or potential barriers to care, i.e. medical, psychosocial, emotional, socioeconomic, cultural
    • Educates patient/family
      • diagnosis, treatment
      • prevention, early detection
    • Maintains open communication and provides support to patient/family along the continuum of care
    • Advocates for the patient
    • Links patient/family with appropriate resources/services
    • Addresses survivorship issues
  • Goals of Nurse Navigator
    • Improve illness adaptation with better
    • coordination
    • Elimination of barriers to care, i.e. financial and
    • economic, transportation, cultural, fear and poor
    • coordination of care
    • Timely Delivery of Services
  • Patient Navigation Criteria for Breast/GYN
    • 40 years of age or younger
    • High anxiety
    • Difficulty in understanding disease concepts and treatment
    • Complex socioeconomic situation/issues
    • Low literacy
    • Bilateral disease
  • Outcome Measures
    • Patient Satisfaction Survey - Scale 1-5
    • How well do you feel your nurse navigator listens to and addresses your concerns?
    • Helpfulness in providing you with information about your condition and treatment.
    • Helpfulness in providing you with information about support groups and programs.
    • If you had side effects of treatment, how effective was your nurse in helping with these problems?
    • Overall how would you rate your nurse navigator?
    • Have the services provided by our patient navigator helped you cope better with your disease and treatment?
    • Question
    • Do you feel your nurse navigator cares about you and your well-being?
  • Outcome Measures
    • Patient Satisfaction Scale
      • Excellent (5)
      • Very Good (4)
      • Good (3)
      • Fair (2)
      • Poor (1)
      • Does not apply
  • Outcome Measures
    • Patient Comments
    “ This is an excellent program. After being diagnosed, I was in a state of shock! Debra has helped clarify what the doctor’s plan of action and lab reports meant. She has been an excellent liaison, and true help in a very difficult time.” “ Debra did an outstanding job in serving as a resource for both my doctors and me. Her warm compassionate mannerism is to be commended. She has a way of making you feel that you are her only patient. Debra truly cares about her patients. Breast cancer is very scary and the journey is difficult. Debra walks the journey with you – calming your fears and reassuring you there’s HOPE for tomorrow.”
  • Outcome Measures
    • Physician Satisfaction Survey - Scale 1-5
    • Are you utilizing the PCMH RN Navigator, Debra Mascarenhas, for assistance with your patients?
    • How would you rate the patient navigator overall?
    • How would you rate the patient navigator on the following?
    • - Eliminating barriers to care
    • - Helping patients to understand and cope better with their disease
    • - Linking patients with appropriate resources to meet their needs
    • Question
    • Do you feel the patient navigator has been a benefit to your patients?
  • Outcome Measures
    • Physician Satisfaction Scale
      • Excellent (5)
      • Very Good (4)
      • Good (3)
      • Fair (2)
      • Poor (1)
  • Outcome Measures
    • Physician Comments
    “ Increased comfort level of patients thus improving oncology compliance and other treatment outcomes. Improved communications related to procedures enhancing patients’ care.” “ Has made it much easier for patients to get through the system of multidisciplinary care and provide physical and psychological support during difficult times for our patients.” “ Debra develops trusting relationships with the patients prior to their visit in the outpatient setting, thus developing a lesser means of patient adaptation to the outpatient setting. She is a mediator between patient/MD, her additional educational opportunities help the patients greatly.”
  • Outcome Measures
    • Patient Volume
  • Outcome Measures
    • Referrals to PCMH/ECU Program because of
    • Nurse Navigator
      • 2010 - 8 patients chose or selected to have their care in Greenville due to the Navigation Program
      • 2011 - 11 patients chose or selected to have their care in Greenville
  • Outcome Measures
    • Uninsured/underinsured linked to programs for treatment coverage
      • Breast and Cervical Cancer Control Program
      • Medicaid
      • North Carolina Cancer Fund
      • Medicare
  • Patient Navigation Marketing
  • Patient Navigation Marketing
    • Patient Health Navigation
    • Cancer Services began its patient navigation program in Fall 2007. This program guides newly diagnosed patients and their family members to various services and resources they need for receiving the best cancer treatment. Patient navigation programs are part of a growing trend in
    • our country that involves the development of special services to help patients through the maze of appointments, treatments and follow-up that are necessary components of cancer care. Here at PCMH, referrals come from private practice physicians and Leo W. Jenkins Cancer Center. Pitt County Memorial Hospital has a registered nurse, Debra Mascarenhas, dedicated to
    • helping patients find answers and support for their health care. Ms. Mascarenhas, who monitors gynecological and breast cancer cases, first meets a patient at the time of her diagnosis and is present when the physician explains the phases of treatment. Ms. Mascarenhas facilitates support services and helps patients find financial, transportation and other resources Most patients referred are under the age of 40 and are dealing with the emotions that accompany a cancer diagnosis. Oftentimes patients have problems understanding the disease or have difficulty coming to terms with their conditions and treatments. A navigator can: provide education on various support programs that help patients cope with their cancer experiences help patients desiring a link to other survivors locate local support groups for patients living outside the Greenville area to reduce the difficulty of travel.
  •  
  •  
  • Types of Navigators / Navigation Resources
    • RNs
    • Social Workers
    • Advanced Practice RNs / PAs
    • Lay People / Community Advocates
  • Issues for Cancer Survivors
    • Physical
    • Psychological
    • Social
    • Spiritual
    • Economic
  • Survivorship – Program Development
    • Program Start
    • Staff selection
    • Staff Training
    • Existing Services
    • Funding
  • IOM’s focus for health professions, education and improved workforce performance.
    • Patient-centered care
    • Work in interdisciplinary teams
    • Employ evidence-based practice
    • Apply quality improvement
    • Utilize informatics
  • CoC Standards - New
    • Standard 3.1 Patient Navigation Process
      • A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The navigation process is evaluated, documented and reported to the cancer committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment.
  • CoC Standards - New
    • Standard 3.3 Survivorship Care Plan
      • The Cancer Committee develops and implements a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee and documented in minutes.
  • Nationwide Free Sources of Patient/Family Information
    • American Cancer Society (ACS)
    • American Institute of Cancer Research (AICR)
    • Lance Armstrong Foundation
    • National Cancer Institute (NCI)
    • National Coalition for Cancer Survivorship
    • Susan G. Koman for the Cure
  • Nationwide Free Sources of Patient/Family Information (cont.)
    • FertileHope
    • Needy Meds
    • Shop Well With You
    • Women’s Cancer Network
    • Support for People with Head & Neck Cancer
    • National Prostate Cancer Coalition
    • The Oral Cancer Foundation
  •  
  •  
  •  
  •  
  •  
  •  
  • Survivorship 101 Results
    • Patients in active treatment showed a greater improvement than those in post-treatment.
    • 17/23 survivors showed weight reduction
    • 10/23 survivors had improved BMI
    • 15/23 survivors reduced waist size
    • 17/23 survivors reduced hip size
    • 11/23 survivors reduced body fat %
    • Four participants have enrolled at a fitness center.
  •  
  •  
  •  
  • Survivor quotes
    • “ Survivorship means being given a second chance at life.”
    • “ Survivorship is being here to share stories with other people who are just starting.”
    • “ Survivorship has given me the chance to teach my kids how to live.”
    • “ Survivorship is the ultimate understanding of one’s purpose in life.”
    • “ Survivorship is about acceptance, determination, and attitude.”
    • “ Survivorship is far more than living through cancer treatment – it’s who I am.”
  • References
    • American Cancer Society, (2011) Cancer Facts and Figures 2011. Retrieved from http://www.cancer.org/research/cancerfactsfigures/cancer-facts-figures-2011 .
    • Case, M. (2011). Oncology Nurse Navigation: Ensuring Safe Passage. Clinical Journal of Oncology Nursing , 15(1), 33-40.
    • Center for Disease Control and Prevention and Lance Armstrong Foundation. A National Action Plan for Cancer Survivorship Advancing Public Health Strategies . (2004). Atlanta, GA: U.S. Government.
    • Grant, M., Economou, D., and Ferrell, B. (2010). Oncology Nurse Participation in Survivorship Care. Clinical Journal of Oncology Nursing, 14(6), 709-715.
    • Institute of Medicine. (2008). Cancer Care for the Whole Patient. Washington, DC: National Academies Press.
    • Koh, C., Nelson, J., and Cook, P. (2011). Evaluation of a Patient Navigation Program. Clinical Journal of Oncology Nursing, 15(1), 41-48.
    • Lagrosa, D. (2010). Launching the Navigation Program that is Best for You – Part 1: Defining Your Program. Journal of Oncology Navigation and Survivorship, 1(3), 1-3.
    • Lagrosa, D. (2010). Launching the Navigation Program that is Best for You – Part 2: Justifying Your Program. Journal of Oncology Navigation and Survivorship, 1(5), 1-3.
  • Questions
  • Evaluation and Measurement of a Patient Navigation Program Marie S. DeStefano, RN, MSN, FAAMA Administrative Director of Oncology Crozer-Keystone Health System, PA
  • Burden of Cancer
    • 2011 U.S. Incidence – 1,596,670 new cases; Deaths - 571,950
    • 2011 PA. Incidence – 78,030 new cases; Deaths – 28,560
    • US Cancer Survivorship – over 12 million
  • Crozer Keystone Health System
  • Crozer-Keystone Health System
    • Full spectrum of health care — from wellness and prevention to acute and tertiary care.
    • CKHS is a not-for-profit integrated health system (501C3 status), established in 1990
    • Committed to improving health and quality of life of nearly 1 million people in service area
    • two-thirds of citizens of Delaware County.
    • Largest employer (6,800) and health care provider in Delaware County. Health system employs more than 300 primary care and specialty physicians.
    • Key stats; 131,500 ER visits, 43,400 admissions, 21,800 surgeries and 3,750 births (FY ’08)
    WHAT WE DO
  • Crozer-Keystone Cancer Centers
    • Partnership with Fox Chase Cancer Center
    • Accredited by the American College of Surgeons Commission on Cancer
    • Philadelphia Cyber Knife
    • 2,200 new cases yearly
    • 381 breast cases
    • Healthy Woman Provider
    • Susan G. Komen Grantee
  • Patient Navigator Outreach and Chronic Disease Prevention Act of 2005
    • Signed into law in June of 2005
    • Authorizes $25 million in grants over 5 years
    • Grants are to recruit, assign, train and employ patient navigators
    • Emphasis on addressing health disparities
  • Patient Navigator Outreach and Chronic Disease Prevention Act of 2005
    • Navigators should:
      • Anticipate, identify, and help patients to overcome barriers within healthcare system
      • Assist in coordination of health care services & referrals
      • Facilitate involvement of community organizations in assisting individuals at risk for or who have cancer or other chronic diseases
    • Complexity of Healthcare Systems
    • Disease specific needs
    • Patients “slip through the cracks”
    • Barriers to care
    • Health Disparities
    • Local competition with out migration
    • Ongoing gap analysis
    Why do we need Patient Navigation? PATIENT NAVIGATION
  • Navigation Opportunities
    • Outreach/Screening Diagnosis Treatment Survivorship
    Freeman, H. (2009). Patient navigation across the healthcare continuum. Retrieved March 20, 2010 from http://www.hpfreemanpni.org/patient-navigation/
  • Does your facility have a Patient Navigation Program?
    • 1. Yes
    • 2. No
  • Job Description
    • Little agreement to definitions of key elements pertaining to nurse navigation
      • What should be included in job description?
      • What kind of educational background should a navigator have?
      • What is the best navigation model?
      • Who should navigator report to?
      • How should navigator interact with other members of the team?
  • Do you know your job description?
    • 1. Does is describe what you do?
    • 2. Did you have input?
    • 3. Is it realistic?
    • 4. Are you measured by goals achieved?
  • Multidisciplinary Team Social Services Radiologist Oncology Nurses Navigator Plastic Surgeon Supportive Services Radiation Oncology Medical Oncology Radiologist Pathologist Genetic Counselor Surgeon PCP/GYN PATIENT
  • What disease sites are part of the Navigation Program?
    • 1. Breast
    • 2. GI
    • 3. Thoracic
    • 4. Head and Neck
    • 5. All
    • 6. Other
  • Navigation
    • Finding the “niche”
    • Establishing goals
    • Getting physician's buy in
    • Skating in new territories
    • Selling our service
    • Reports to Administrator Oncology Services
    • Reports to Cancer Committee
    • “ I am here to compliment your practice”
  • History of Navigation CKHS
    • DCMH: 2005 First Patient Navigator-Breast
    • CKHS: Financial Navigator/Komen/Healthy Women
    • Decreased in patient out migration
    • 18% to 1%
    • Decrease in timeliness to care
    • Increase in Patient Satisfaction
    • Increase in Physician Satisfaction
    • 2006 Breast Patient Navigator hired at CCMC
  • Breast Program at CKHS FY10
    • Breast Imaging Center of Excellence by ACR
    • NABPC 2009-National Accreditation Breast Program Center-ACOS
    • 22,142 Screening mammograms
    • 8,163 Diagnostic Mammograms
    • 1746 Breast procedures
    • 362 Cases of Breast Cancer
  • Breast Program at CKHS FY11
    • Joint Commission Disease Specific Accreditation
    • 22,390 Screening mammograms
    • 8,533 Diagnostic Mammograms
    • 1,712 Breast procedures
    • 381 Cases of Breast Cancer
    • 2.19% increase from FY10
  • Virtual Model of Navigation
    • Coordinating Multidisciplinary care from time of initial imaging abnormality
    • Women’s Diagnostic Center
    • Bi-Rad 4 or 5
    • Percutaneous Biopsy
    • FNA
    • 1-866-965-HOPE
    • [email_address]
  • Benign Percutaneous Biopsy Surgeon Abnormal Malignant 6 month f/u imaging Palpable not see on imaging Not a candidate for Percutaneous biopsy Abnormal imaging BHC
  • Breast Panel Review Medical Oncology Radiation Oncology Reconstructive Surgeon Genetic Counselor Definitive Treatment Plan Supportive Services
  • Is it Working?
    • How do we capture?
      • Monthly reports to administrator
      • Number of patients seen/contacted
      • Number of Bi-Rad 4 & 5
      • Number Staying in system
      • Number out migration
      • Number newly diagnosed
  • Breast Health Coordinator STATS July 2010 CCMC Springfield Media Brinton Lake Total 24 5 0 1 Seen or Contacted 24 5 0 1 Stayed in System 21 5 0 1 Out migrated 3* 0 0 0 Patient Contacts = 59 Total New Bi-Rad 4 or 5 = 30 Total New malignancy New Breast Cancer Staying in System = 6 *Reason for Outmigration Pt referred by Dr. Vakil, preferred surgical biopsy with him Pt biopsy here- benign- to Jeff Pt referred to Lankenau by Dr Tirado
  • Lung Cancer Navigator
    • Total number of lung - 341
    • How to capture patients
      • Screenings
      • Incidental findings
      • Pathology reports
      • Direct referrals
      • Physician referrals
    • What to report for ROI to administration
      • # of the diagnostic procedures
      • # of therapeutic procedures
      • # of radiation patients, including CyberKnife
      • # of patients contacted, those staying in system, those out migrating and why
  • Colon Cancer Navigator
    • Total number of Digestive System Cancers – 343
    • Total number of Colorectal cancers - 202
    • How to capture patients
      • Screenings
      • GI suite
      • Pathology reports
      • Direct referrals
      • Physician referrals
    • What to report for ROI to administration
      • # of the diagnostic procedures
      • # of therapeutic procedures
      • # of radiation patients
      • # of patients contacted, those staying in system, those out migrating and why
  • Outmigration Statistics 2006-2010
  • We Think So!
    • 98.86%
    • of newly diagnosed breast cancer patients stayed in our system for care
  • What Administration Wants: ROI Referrals From Patients Referrals for Supportive care Additional Radiographic Imaging Medical Oncology/ Chemo Radiation Therapy Surgery Surgical Consult Percutaneous biopsy Ultrasound Diagnostic mammogram Screening mammogram
    • Number of patients
    • Demographics of each
    • Stage at diagnosis
    • Appointments kept/missed/why
    • Patients accepting not accepting navigation/reasons
    • Timeliness of care
    • Education information provided
    • Barriers/Resolution
    • Resources (internal/external)
    • Clinical Trial opportunities/accrual
    • Outmigration
    • Downstream revenue
    Qualitative/Quantitative Measures PATIENT NAVIGATION
  • Additional Benefits
    • Increased patient Satisfaction
    • Quality Improvement opportunities
    • Partnerships with Community
    • Identifying high risk patients for PARCA program
    • Screening for Clinical Trials
    • Identifying Gaps and weakness in services
    • Sustained Volume, Decrease in out migration: expansion of Navigation Program
    • 2010 Lung & Colorectal Navigator at CCMC & DCMH
  • Final Thoughts
    • Team approach
    • Identify gaps
    • Set goals
    • Make contacts
    • Find point of contact with patients
    • Evaluate process
    • Be Flexible!
  • One Size Does Not Fit All