Boston Medical Center Cancer Care Patient Navigation Program: Standardized Documentation in Patient Navigation at Boston Medical Center

Background: Boston Medical Center (BMC) is a private, not-for-profit academic medical center and the primary teaching affiliate for Boston University School of Medicine. It is a safety-net hospital, with approximately 65% of patients coming from neighborhoods with the highest levels of mortality and health disparities. With support from private grants and hospital funding, the patient navigation  program was developed in 2005 in the Section of Hematology and Oncology. It now comprises 4 full-time patient navigators (PNs), with over 400 patients currently enrolled.

Methods: The patient navigation program uses a myriad of standardized and secure tools on a daily basis that aid in its success. In 2010, the PNs created the Patient Navigation Note in the electronic medical record. Developed with reporting capabilities in place, the Note is a valuable tool used to capture information such as barriers to care, time spent with a patient, demographic information, and documentation of resources utilized.

Results: A monthly report generated by the Information Technology Department summarizes the data, providing valuable statistics and quality assurance. For example, the program’s most recent report showed a total of 1217 patients were entered into the patient navigation program between November 2011 and June 2012. Of those patients, 73% were of minority background, and 31% did not speak English. The most common barriers faced by these patients were transportation (25% of patients), followed by language (11% of patients). On average, the PN contacted each patient 4 times and spent approximately 47 hours a month either coordinating patient care or working directly with a patient. In addition to the significant amount of data the Note provides, it has also proven to be a useful communication tool between the PNs and the clinical team. The Patient Navigation Note is now utilized by PNs in different departments within the medical center, as well as affiliated Community Health Centers. The PNs developed a standardized operating procedure (SOP) with specific details on how to properly and uniformly use the Note. The SOP is used as a training tool for new staff and to ensure consistency in PN documentation. Reports generated from the notes are used to evaluate the program’s effectiveness, provide information to hospital administration, and support funding applications.

Conclusion: Looking forward, the Patient Navigation Note will reveal the necessity of the PN role and the impact of the PN within the community.