Improving Patient Referral Services Through Oncology Patient Navigation

November 2018 Vol 9, NO 11
Kathleen Gray, RN
Oklahoma City Indian Clinic
Stephanie Harris, RN
Oklahoma City Indian Clinic
Ashton Gatewood, MPH, BSN, RN
Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK
Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Office of Medical Student Research, Tahlequah, OK

Background: According to the Centers for Disease Control and Prevention, overall cancer death rates went up among AI/AN men and women from 1990 to 2009, while overall cancer death rates went down among white men during this time, and among white women from 1993 to 1998 and 2001 to 2009.1 Oncology care is overwhelmingly complicated for patients and providers. Oncology patients are seen by multiple specialists, including but not limited to medical oncologists, surgeons, and radiation oncologists as well as laboratory services and radiology. During treatment, oncology patients need time-sensitive and often complex care coordination. Historically, Indian Health Services has been difficult for patients, families, and their providers to navigate. This leads to prolonged diagnosis, delayed treatment, missed referrals, or patients lost to follow-up. Contract Health Services (CHS) case managers are inundated with the complexity of oncology referrals and processing STAT and urgent oncology referrals. The purpose of this study is to improve the oncology patient services mentioned above through specializing referrals by providing oncology case manager navigation.

Objectives: The first objective is to provide patients with a skilled advocate and educator to navigate them through their cancer journey. After reviewing the time, attention, and number of referrals required for the oncology patients, it was evident that a full-time oncology case manager was needed. The second objective is to increase oncology referrals by 50% from 2016 to 2017 by adding the specialized oncology case manager. The third objective is to develop an oncology patient registry by the end of 2017. The oncology patient registry will collect demographics on patients. Any patient with a diagnosis of cancer is added to the registry. This allows the case manager to query specific information regarding diagnosis, age, physician, treating facility, and insurance.

Methods: Baseline data was obtained from a retrospective chart review. The Resource and Patient Management System (RPMS) was queried and the CHS case manager spreadsheet analyzed for oncology referral totals. The CHS case managers completed approximately 244 oncology referrals in 2016. The RPMS and CHS and oncology case manager spreadsheets were reanalyzed at the end of 2017. Data set comparison was made between January to December 2016 and January to December 2017.

Results: Adding an oncology case manager to specialize the process increased oncology referrals approximately 200% and medical referrals approximately 10% from 2016 to 2017. The CHS case managers increased their percentage of referrals processed because they no longer had to tackle the complex oncology referrals.

Conclusions: Overall patient navigation improved by specializing the referral process with a designated oncology case manager. The number of oncology and medical referrals processed both increased. In addition, the oncology patient registry resulted in increased numbers of oncology patients identified and navigated through their cancer journey. Demographic data captured by the oncology patient registry will continue to benefit patients by guiding future quality improvement projects.


  1. White MC, Espey DK, Swan J, et al. Disparities in cancer mortality and incidence among American Indians and Alaska Natives in the United States. Am J Public Health. 2014;104(suppl 3):S377-S387.
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