The Impact of Navigation Program Development on Outmigration

November 2019 Vol 10, No 11
Jolene Hetsler, RN, ONS
Sarah Cannon
Lisa McGuire, MBA, BSBM
HCA Healthcare
Ocala, FL
Michelle Sawdon, RN, CBCN
Sarah Cannon
Nashville, TN

Background: The program began with a general focus navigation model (breast, lung, gastrointestinal cancers), then transitioned to a breast navigation only model in March 2018 due to patient volumes and navigator bandwidth. While transitioning from a general nurse navigation model to disease site–specific model, there was opportunity to evaluate the effect of this change on patient retention versus outmigration. A lung-specific navigator began in November 2018.

Objectives: Trends in patient retention were reported monthly. Navigators collaborated with leadership, marketing, and affiliated physicians during the report outs to limit outmigration.

Methods: A proprietary software reporting tool to collect and compare data in 5-month intervals was used. Also tracked manually any changes in operations during same time frame. The time line is January 2018 through March 2019 and includes all patients who were navigated from the 2-hospital health system. Patients referred out with their best interest in mind to maximize insurance coverage or secure treatment closer to home, and physician refusals, were excluded. Only those patients in the affected tumor types were monitored for outmigration.

Results: Average patient retention was 67.4% in the first reporting period prior to the navigator focus change. Outmigration was 32.6%. The average number of patients per month was 26.8, with a desired productivity of 16.7 patients per navigator. Physicians were engaged and educated to the change in the model, and marketing rack cards were changed to show the focus to a single tumor type prior to the second period. In the second period, the navigator was dedicated to breast cancer—75.4% retention, 24.6% outmigration, 8% increase in patient retention. The average number of patients per month was 12.8. The lung physicians requested thoracic navigation abilities during this period. Leadership approved the addition of a second navigator. The third period revealed average patient retention of 85.6% and 14.4% outmigration. Additional overall retention increased 10.2%. Added lung-specific navigator in third period. The lung and breast navigators navigated a total of 28.8 patients per month.

Conclusion: Overall, the program realized an increase of 18.2% in patient retention over a 15-month period. In evaluating the program’s evolution, the trend showed a decrease in the overall outmigration and an increase in retention percentages in each consecutive specified time frame. This validated the best practice of establishing tumor site–specific navigation to meet the needs of this health system. The navigator had productivity rates closer to 100% in tumor site–specific navigation than in the general navigation model, which was 161% productive. Additionally, engagement between leadership, navigators, marketing, and physicians aligned to decrease patient outmigration, resulting in increased patient retention.

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Last modified: May 10, 2021

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