AONN+ Metrics: Measuring the Impact of Hispanic Patient Navigation in North Carolina

Background: Hispanics have unique healthcare needs and face significant health disparities. To address these needs, a bilingual/bicultural Hispanic patient navigator (HPN) position was developed to support Hispanic adult/pediatric patients treated at Wake Forest Baptist Comprehensive Cancer Center (WFBCCC). The HPN works across the cancer continuum beginning with community outreach and supporting patients through diagnosis to survivorship and/or end-of-life care.

Objectives: To evaluate the initial services provided by the HPN and the accompanying metrics for alignment with the Academy of Oncology Nurse & Patient Navigators (AONN+) Standardized Metrics.¹ Opportunities for revision and implementation of additional metrics to improve reportable outcomes of the patient navigation program at WFBCCC are anticipated moving forward to provide ongoing exceptional cancer care for Hispanics.

Methods: Retrospective data from 11/1/2015 to 10/31/2017 were obtained from a REDCap database, Epic Healthy Planet, and a clinical trial system. Data are reported in the aggregate, and clinical trial participation rates were compared with data prior to the HPN. Data captured were compared with the AONN+ recommended standard metrics.

Results: Data reported on the following metrics were captured from 11/1/2015 to 10/31/2017.

• Metric #2: Barriers to Care – The most common barriers to care identified were financial/insurance (61%), transportation (58%), communication (58%), continuity of care (32%), and clinical trials (22%)
• Metric #3: Interventions – In addition to referrals, the HPN intervened to remove potential barriers to care through transportation assistance (31%), meal vouchers (21%), and parking validation (40%)
• Metric #4: Clinical Trial Education – The HPN educated Hispanic cancer patients about clinical trials, and clinical trial participation among Hispanic patients navigated was 52%
• Metric #10: Patient Experience – The Hispanic patients completing the satisfaction with navigation survey reported 97% satisfaction with navigation services provided, which may lead to new and repeat service utilization over a longer life span²
• Metric #13: Diagnostic Workup – The HPN navigated Hispanic breast screening/diagnostic patients, and 89% of individuals met the benchmark of <45 days between abnormal mammogram and definitive diagnosis. A diagnostic interval >60 days is associated with later-stage diagnosis³
• Metric #16: Caseload – 208 pediatric and adult patients were navigated; 78 navigated in the breast screening/diagnostic phase and 130 patients during cancer treatment. Contact is made with all newly diagnosed patients
• Metric #24: Screening – The HPN facilitated free mammograms for 116 uninsured Hispanic women during community outreach events, maximizing community benefits and increasing access to care for a vulnerable population⁴
• Metric #26: Screening Events – The HPN participated in 25 community outreach events, providing information to about 4102 attendees, mostly Hispanics

Conclusions: The HPN data indicate an initial success in navigating the Hispanic population early in the cancer continuum, demonstrating patient satisfaction, and an increase in clinical trial participation among Hispanic cancer patients. HPN data are currently reportable in 4 of the 8 navigation domains across 8 of the AONN+ standardized metrics. Opportunities exist to utilize existing data to report on additional metrics and domains. Placing HPNs in cancer treatment settings demonstrates an effective method of providing navigation, while also facilitating state-of-the-art culturally and linguistically appropriate care.

References

1. Strusowski T, Sein E, Johnston D, et al. Standardized Metrics Source Document. Academy of Oncology Nurse & Patient Navigators. 2017:12-69. https://aonnonline.org/images/articles/standardized_metrics/Metrics-Source-Document.pdf.
2. Hopkins J, Mumber M. Patient navigation through the cancer care continuum: an overview. J Oncol Pract. 2009;5:150-152.
3. Arnsberger P, Fox P, Ryder P, et al. Timely follow-up among multicultural women with abnormal mammograms. Am J Health Behav. 2006;30:51-61.
4. Simon MA, Tom LS, Nonzee NJ, et al. Evaluating a bilingual patient navigation program for uninsured women with abnormal screening tests for breast and cervical cancer: implications for future navigator research. Am J Public Health. 2015;105:e87-e94.