Outcomes Management in Oncology Patient Navigation

Background: Navigators educate and assist patients through their continuum of care from diagnosis, during treatment, and throughout survivorship. At Spartanburg Regional Healthcare System, the success of the breast and lung nurse navigator programs led to a goal of increasing the nurse navigation roles to include other cancer sites. To validate the impact of oncology patient nurse navigators, MIDAS was used to collect data on the number of patients served and nurse–patient encounters, including visits during treatment, phone calls, educational sessions, and case management work such as referrals to a social worker, community resources, and/or other disciplines such as genetics and dietetics. These data were used to validate quality outcomes and the return on investment (ROI). A reduction in the number of admissions results in cost avoidance throughout the navigated patient’s continuum of care. Patient and physician satisfaction surveys also were used to validate the increased quality of care and satisfaction with oncology patient navigators.

Objectives: (1) To determine if positive ROI results are associated with navigated oncology patients. (2) To identify the patient and physician level of satisfaction when using oncology patient nurse navigators to provide a continuum of care.

Methods: The methods used to collect data included gathering data from the MIDAS database, the STAR database, and patient and physician satisfaction surveys. The data gathered from the STAR database included emergency room visits and admissions during cancer treatment for those patients with prostate and colorectal cancer diagnosis. All data were reviewed and analyzed for a 6-month period prior to navigation services and for 6 months after implementation of navigation services at Spartanburg Regional’s Gibbs Cancer Center. Patient satisfaction surveys were distributed to 30% of navigated patients. Physician satisfaction surveys were distributed to those who had utilized the services of an oncology nurse navigator.

Results: The analysis of MIDAS data revealed total interventions for a 6-month period were 891 for breast, 658 for prostate, 321 for lung, and 113 for colorectal navigation. The case management hours revealed 236, 242, 38, and 306 hours, respectively, during this same period. Case intensity in hours is directly related to intensity of services required of the navigated patient. Only 2 patients were admitted during their treatment for prostate cancer after the implementation of an oncology nurse navigator compared with 13 patients the previous 6 months. Six colorectal patients were admitted compared with 15 the previous 6 months. Decreased admission rates resulted in cost avoidance and enhanced quality of care. There was 36% return on patient satisfaction surveys, which revealed 100% of patients “strongly agreed” or “agreed” that the oncology nurse navigator had a positive impact on their care, and all would refer a relative/friend to the Gibbs Cancer Center. The physician satisfaction surveys, with a 100% return, showed all physicians “strongly agreed” the services of a navigator were valuable.

Conclusions: Oncology patient navigation is a valuable service that positively impacts care. Results demonstrate reduced admissions, enhanced satisfaction, and improved quality of care. This leads to the conclusion that oncology patient navigators provide important education, resources, support, and coordination of care throughout the continuum.