Patient Navigation

Recommendation:

A patient navigation program is available for patients, their families, and caregivers to help overcome healthcare system barriers and facilitate timely access to quality medical and psychosocial care from pre-diagnosis through all phases of cancer.

Overview

Patient navigation refers to individualized assistance to help patients access the healthcare system and adhere to cancer treatment and supportive care. Navigation helps patients address barriers to timely, quality health and has become a service valued by patients and providers. Duties can be performed by a nurse navigator, a social worker, or a patient navigator without a clinical license. Skills and background should be matched with institutional goals and patient needs identified through a Community Needs Assessment (CNA). Corollary navigator role boundaries and actions should be based on the level of navigator hired. The Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC) require accredited programs to have a navigation process.

Standards

• National Accreditation Program for Breast Centers, NAPBC Standards 2.2

Certification

The National Consortium of Breast Centers offers breast navigator certification AONN+ offers certification for nurse navigators and patient navigators as of 2016.

Resources to Help

• ACCC Patient Navigation Resources & Tools
• Academy of Oncology Nurse & Patient Navigators (AONN+)
• C-Change Patient Navigation Toolkit
• Harold P. Freeman Patient Navigation Institute
• The GW Cancer Institute Oncology Patient Navigator Core Competencies
• The GW Cancer Institute Oncology Patient Navigator Training
• Oncology Nursing Society Oncology Nurse Navigator Core Competencies
• Patient Navigator Training Collaborative

Caseload Benchmarks

The number of patients a navigator is expected to assist varies based on type of cancer, level of patient need and point in the cancer care continuum. While there are not clear caseload standards at this time, generally navigators who serve patients on the screening end of the continuum can manage a larger patient load. Given both the length and complexity of treatment, those who are navigating a patient through treatment carry smaller caseloads. For high-risk, co-morbid and/or low-income patients or with those with other substantial needs, caseload based on a recent large navigation study by Rocque and colleagues averaged roughly 100 patients per year. Based on a recent research abstract, number of patients navigated per day for one program ranged from 7-53 patients (Howard et al., 2010).

Insurance Considerations

Currently navigation services are not routinely reimbursed; however, navigation is a requirement under the Centers for Medicaid & Medicare Services Oncology Medical Home model of care. Documentation of both service and value - such as improved patient experience, care efficiency, care coordination, and outcomes - can assist administrators in negotiation with payers. Recently, a large study at the University of Alabama showed reduced ER visits, unplanned hospital admissions and overall cost of care per patient in a CMS study (Rocque et al., 2015). The GW Cancer Center has created the Patient Navigation Barriers and Outcomes Tool^TM (PN-BOT^TM) to help navigators document the value of their work (Pratt-Chapman, 2016).

References

Howard MB, Freund K, Battaglia T. Caseload for patient navigation: What is keeping navigators busy? Cancer Epidemio Biomarkers Prev. 2010. Abstract A26:

Pratt-Chapman M, Phillips S, Raskin S. Patient Navigation Barriers and Outcomes Tool. 2016. The George Washington University. Washington, DC. Available at https://smhs.gwu.edu/gwci/BarriersTool

Rocque GB, et al. Trends in resource utilization and costs during implementation of a lay navigation program. J Clin Oncol. 2015;33(suppl; abstr 6502).