Patient and nurse navigators play an important role in the care of patients from screening through treatment and into survivorship. Whether helping address barriers to care, coordinating care, supporting transitions [ Read More ]
January 2018 VOL 9, NO 1
The Metrics Initiative: What Is Next?
Cheryl Bellomo, MSN, RN, ONN-CG, OCN; Danelle Johnston, MSN, RN, ONN-CG, OCN, CBCN
For the past 2 years, the annual Academy of Oncology Nurse & Patient Navigators (AONN+) conference has been the place to learn what is exciting and happening in the standardized metrics initiative. In fall 2015, responding to a need by membership for metrics that reflect the impact of navigation and to demonstrate program success, the Standardized Navigation Metrics Task Force was formed. After an extensive literature review of over 300 source documents, the 35 standardized metrics based on the 8 domains of certification for navigation were announced at the annual conference in 2016.1 So what will be the next phase of the metrics initiative?
As announced at the 8th Annual Conference in November 2017, the second phase of the metrics initiative will be the development of a metrics repository for navigation/cancer programs to report outcomes, lessons learned, and performance improvement initiatives that have been implemented to enhance and improve navigation processes. Phase 2 is a metrics research study in which selected navigation/cancer programs utilizing a cloud-based business intelligence tool will be identifying core metrics, standardizing data collection, and demonstrating program outcomes.
The goals of the phase 2 project include:
- Implementation of metrics and reporting of outcomes with data analysis
- Establishing evidence-based, national standardized navigation benchmarks
- Navigation research to validate sustainability and value of navigation
- Identification of navigation best practices and lessons learned
- Creation of a centralized navigation metrics database and repository
The 10 core metrics that will be identified for the study include:
- Coordination of Care/Care Transitions: Barriers to care; measuring the number and list of specific barriers to care identified by navigator per month
- Coordination of Care/Care Transitions: Diagnosis to initial treatment; measuring the number of business days from diagnosis (date pathology resulted) to initial treatment modality (date of 1st treatment)
- Operations Management/Organizational Development/Health Economics: Navigation caseload; measuring number of new cases, open cases, and closed cases navigated per month
- Operations Management/Organizational Development/Health Economics: Measuring the number of navigated patients readmitted to the hospital at 30, 60, and 90 days
- Psychosocial Support Services/Assessment: Psychosocial distress screening; measuring the number of navigated patients per month who received psychosocial distress screening; at a pivotal medical visit using the National Comprehensive Cancer Network distress screening tool
- Psychosocial Support Services/Assessment: Social support referrals; measuring number of navigated patients referred to support network per month
- Survivorship/End of Life: Palliative care referral; measuring number of navigated patients per month referred for palliative care
- Patient Advocacy/Patient Empowerment: Identify learning style preference; measuring the number of navigated patients per month whose preferred learning style was discussed during the intake process. The group agreed this should be included if we can identify a validated tool
- Professional Roles and Responsibilities: Navigation knowledge at time of orientation; measuring percentage of new hires who have completed institutionally developed navigator core competencies
- Research/Quality/Performance Improvement: Patient experience/patient satisfaction with care; measuring patient experience or patient satisfaction survey results per month. The group determined use of CCHAPS (Community-wide Children’s Health Assessment & Planning Survey) for measuring patient satisfaction
For the pilot study, 2 National Cancer Institute–designated academic medical centers, 2 Commission on Cancer (CoC)-accredited community-based cancer centers, 2 freestanding physician practices that participate in the Oncology Care Model, and 2 basic cancer programs that have no metrics or reports in place will be chosen through an application process to participate in this national research study.
Research study inclusion criteria include:
- Current AONN+ members
- Percentage of analytic cases
- Percentage of navigators to analytic cases
- Current and active participation in national accreditation programs
- Some examples are: CoC ± National Accreditation Program for Breast Centers, Quality Oncology Practice Initiative, and Oncology Care Model
Research study organizational requirements include:
- Signed memorandum of agreement
- Confidentiality agreement
- Institutional review board study approval
- Agreeable to on-site visits and data review
- Participation in training
- Assignment of project leader
- Data collection and submission
- Electronic health record and/or billing system data mapping
- Use of new cloud-based business intelligence tool
- Publication of study results
- Ongoing data sharing
The Institute of Medicine (IOM) call to action addresses gaps in cancer quality care that span the continuum of cancer care. The IOM, in the report Ensuring Quality Cancer Care, stated, “To ensure the rapid translation of research into practice, a mechanism is needed to quickly identify the results of research with quality of care implications and ensure that it is applied monitoring quality.”2 The IOM has identified disparities in existing measures; challenges in measure development; lack of consumer engagement in measuring development; and data support to create meaningful, actionable performance measurement. The elements of quality care defined by the IOM include outlined patient goals, access to full complement of resources to implement plan of care, access to high-quality clinical trials, full disclosure of information about treatment plan, process for coordinated services, and providing psychosocial support services. The AONN+ Metrics Study aligns with the IOM components of quality of care, which require expanded depth in data collection through a common set of data elements, utilization of healthcare information technology for cancer using real-time data analytics, and the development of a national quality reporting program.3
It is imperative that oncology nurse and patient navigators understand that active participation in the data collection, analytics, and reporting outcomes are not added responsibilities but are already a part of the professional role. Continue to watch the AONN+ website for a call to action to submit a letter of intent to apply and participate in phase 2: Navigation Metrics Database and Repository National Pilot Study and IT Platform Development.
It is crucial for navigation to continue to build a strong sustainable business case through the collection, measurement, and reporting of the newly established 35 standardized metrics. Harnessing the power of this information to create best practices will elevate navigation and garner industry support for advancing patient-centered care delivery.
1. Strusowski T, Sein E, Johnston D, et al. Standardized evidence-based oncology navigation metrics for all models: a powerful tool in assessing the value and impact of navigation programs. Journal of Oncology Navigation & Survivorship. 2017;8(5):220-237.
2. Institute of Medicine. Ensuring Quality Cancer Care. Hewitt M, Simone JV, eds. Washington, DC: National Academies Press. 1999.
3. Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Levit L, Balogh E, Nass S, et al, eds. Washington, DC: National Academies Press; 2013.
For additional information, please contact one of the AONN+ Metrics Study Chairs:
Tricia Strusowski, RN, MS
Manager, Oncology Solutions
Chair, Metrics Committee
Chair, Metrics Study
Elaine Sein, RN, BSN, CBCN, Consultant
Co-Chair, Metrics Study
Danelle Johnston, RN, MSN, OCN, CBCN
Chief Nursing Officer, The Lynx Group
Member, Leadership Council
Co-Chair, Evidence into Practice Committee
Co-Chair, Metrics Study
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