September 2016 VOL 7, NO 8

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AONN+ East Coast Regional Meeting

CoC Accreditation Requires Patient Navigation Process

FredGreene98pxThe Commission on Cancer (CoC) serves as a resource and opportunity for improved cancer care. The value of CoC accreditation to an institution is multitudinous, said Frederick L. Greene, MD, in his presentation at the East Coast Regional Meeting of the Academy of Oncology Nurse & Patient Navigators (AONN+).

The CoC is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard setting, prevention, research, education, and the monitoring of comprehensive quality care. AONN+ is a CoC member organization.

Value of CoC Accreditation

Dr Greene highlighted the value of CoC accreditation. An accredited organization demonstrates commitment to patients, communities, providers, payers, and policymakers to improving survival and quality of life for patients and to evidence-based, organized, comprehensive, and quality cancer care.

CoC standards ensure that organizations have state-of-the-art clinical services for diagnosing, treating, rehabilitating, and supporting cancer patients and their families.

Accreditation allows participation in the National Cancer Database (NCDB), which captures more than 100 data elements for every patient and more than 70% of all new cancer patients diagnosed in the United States each year. User file access for research is available only to investigators at CoC-approved programs.

“We have 1520 programs accredited by the Commission on Cancer,” said Dr Greene, Medical Director, Cancer Data Registry, Levine Cancer Institute, Charlotte, NC. “We’re adding significantly to this every year because you have to be accredited to use the NCDB data.”

Quality and outcomes of accredited institutions are measured through a rapidly expanding panel of quality measures for an array of cancer types and compared with nationwide data from all 1500 CoC-accredited programs.

Cancer program and data standards help to establish a framework for organizing patient-centered cancer care that addresses the full continuum of care and needs identified by the Institute of Medicine reports. New patient-focused standards have been developed in response to new issues in healthcare. One standard is genetic assessment and counseling. “We wanted to make sure there is a genetic counselor working with clinicians, working with navigators,” said Dr Greene. Other patient-centered metrics that relate specifically to navigation involve clinical trial accrual, psychosocial distress screening, and a survivorship care plan, as well as palliative care services.

“Going forward in 2017, every one of our institutions will have to be measured as far as their palliative care programs,” he said. “I’m happy to say that’s a continuum of care that we look at in all of our accredited facilities.”

AONN+ will be important in defining new CoC standards, said Dr Greene.

Standard 3.1: Patient Navigation Process

Standard 3.1 describes the characteristics of the patient navigation process. The process is intended to expand the concept of care, improve the coordination of care, and support the customization of care for each individual according to his/her needs and circumstances.

Programs are reminded that navigation is a process, not a person, Dr Greene said. The process is driven by a community needs assessment that identifies disparities and barriers to care for patients. Resources to address the identified barriers can be provided on site or by referral to community-based or national organizations. The navigation process is evaluated annually and then modified. The evaluation process has 4 components: identification of barriers or factors that create disparities in healthcare and outcomes, services, identification of gaps in services or resources needed, and assessment of outcomes.

The cancer committee must be involved in the CoC standards. “This is the one mistake I find as a surveyor in many places,” Dr Greene said. “All of these things are done, but they never get into the minutes of the cancer committee. Make sure that you know who is taking the minutes at your institution, and make sure there’s a specific meeting where navigation and the navigation program is discussed.”

In the community needs assessment, determine if the services are adequate for patient needs, what services might be missing, whether the services are used, whether the services are accessible, and whether staffing is sufficient to provide adequate services.

Patient and provider surveys, focus groups, and use of public information (ie, state department website, demographic data, geographic and transportation information, economic data) are encouraged when assessing community needs.

In assessing the cancer care experience, “appointment coordination is a very important metric,” said Dr Greene. “Am I getting patients in on a timely fashion to the doctor? Am I getting them back to radiation? Am I getting them to the medical oncologist for appointments?”

Outcomes metrics related to patient navigation include:

  • Improved rates of screening and follow-up
  • Lower clinical stage at presentation
  • Improvements in completion of treatments and reported levels of increased psychosocial support
  • Higher patient satisfaction
  • The ability to engage, track, and support patients
  • The ability to develop communication and trust between hospital and disadvantaged populations
  • Increased enrollment and retention into clinical trials

Ultimately, a multidisciplinary approach to cancer care is required. Helping patients and families navigate the continuum of care and focus on healing requires a base of knowledge and expertise that goes beyond any single discipline. “You’re going to have your navigator, the social worker, the psychologist, the nutritionist, financial support group, and the pharmacist,” he said. “They all make up what’s important for you as a navigator.”

Rapid Quality Reporting System

Dr Greene also touched on the Rapid Quality Reporting System (RQRS), which was developed to allow cancer programs to have access to more timely data surrounding their treatment expectations based on adherence to CoC-approved measures. It was developed “to make sure patients don’t fall through a crack in their treatment,” he said.

RQRS allows programs to submit timely cases for assessment to CoC quality measures, to prospectively monitor cases for receipt of adjuvant therapy, and to assess current compliance rates and changes in compliance rates over time.

“The navigators should be very much involved in the RQRS process,” Dr Greene said. “Right now the RQRS process is a commendation standard.”

RQRS currently reports compliance with standards of care for primary cancers of the breast, colon, and rectum, with more cancers to come.

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