Guest blogger, Elaine Sein RN, BSN, OCN, CBCN
Patient navigation and care coordination have been a focus in health care for several years as a result of the fragmentation that commonly occurs between access, diagnosis, and treatment. Evidence shows that in addition to unequal access to health care, racial and ethnic minorities and underserved populations do not always receive timely, appropriate advice and care when faced with a cancer diagnosis (Freeman, 2006).
Care Coordination/Patient Centered Care takes patient navigation to a higher level, one that ensures not only guidance for access, screening, diagnosis, and treatment but also psychosocial care. The Institute of Medicine’s (IOM’s) report, Cancer Care for the Whole Patient, stressed the need that all cancer care should ensure the provision of appropriate psychosocial health services, facilitate effective communication, engage and support patients in managing illness, and systematically follow up on evaluating and adjusting the plan (IOM, 2008). The National Quality Forum (2008) developed a portfolio for care coordination envisioning a system that guides patients and families through their healthcare experience, while respecting patient choice, offering physical and psychological supports, and encouraging strong relationships between patients and the healthcare professionals accountable for their care.
This strong national movement has evidence based research to support the need which has led cancer program accrediting bodies to add patient navigation as a required standard. The National Accreditation Programs for Breast Centers (NAPBC) has had a Patient Navigation standard in place since it was instituted in 2009 and the American College of Surgeons Commission on Cancer (ACOS) will be adding Patient Navigation as standard 3.1 in the revised standards that will go live some time this summer.
A draft of this standard is:
The cancer committee conducts an assessment of barriers to care for patients with cancer. A patient navigation process is established to address barriers to care for patients with cancer and health care disparities either on site or by referral. The cancer committee evaluates and reports on the process annually. (Working draft Cancer Program Standards 2012 Ensuring Patient Centered Care is available here.)
The key to this standard is the fact that each program and institution will be responsible to evaluate the individual needs of the cancer patient population as well as the community they serve to establish a navigation process that suits its needs and determine appropriate staffing.
What does this mean to the navigation programs currently in place versus any new programs? A full assessment reviewing health disparities identified, populations served and barriers identified by the needs assessment will be used to create or revise process currently in place. This standard will require documentation of this process as well as outcome metrics to prove the value of the program. Each program will need to track areas for quality improvement and create action plans to enhance the navigation process. This new standard will be phased in over a three year period by all accredited cancer programs. As we learn more details about how the ACOS plans on implementing this standard as well as resources and tools to assist with creation of new programs we will keep you posted.
Click here for more information on this new standard and the link to the Cancer Program Standards Project Wiki page. This web site provides a vehicle for comments to the standards, so take advantage of this opportunity to voice your comments/questions.
Visit the PA Patient Navigator Network Leadership Team page for more information about Elaine.