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© American College of Surgeons 2013—Content cannot be reproduced or repurposed without written permission of the American College of Surgeons.© American College of Surgeons 2014—Content cannot be reproduced or repurposed without written permission of the American College of Surgeons.

Meeting the Patient Navigation Process StandardNina Miller, MSSW, OSW-C

American College of Surgeons Commission on CancerChicago, IL

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Commission on Cancer Objectives

Establish standards to ensure quality, multidisciplinary, andcomprehensive cancer care delivery.

Conduct surveys in healthcare settings to assess compliancewith those standards.

Collect standardized, high quality data from CoC-accreditedfacilities to measure cancer care quality.

Use data to monitor treatment patterns and outcomes andenhance cancer control and clinical surveillance activities.

Develop educational interventions to improve cancerprevention, early detection, care delivery, and outcomes.

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Institute of Medicine

commission members

change the focus from structure to process and outcomes

direct patient benefits

address the full continuum of care

Considerations for Standards 2012

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respect the values, preferences and expressed needs of patients

coordinated & integrated care across system boundaries

provide the information, communication, and education that people need and want

guarantee physical comfort, emotional support, and involvement of family and friends

Crossing the Quality Chasm: A New Health System for the 21st Century

Institute of Medicine March 2001

Patient-Centered Care

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Patient-Centered

Care

Individualized Care

Family

Respect, Dignity,

Compassion

Information Sharing/

communication

Shared decision-making

Self-management

Access to care/

convenience

Patient-Centered Care Core Concepts to Guide Performance Measurement

National Quality Forum

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Patient centered

care not well implemented

Systems can be complex

and fragmented

Too much unwanted or

unneeded care

Patients excluded from care team and

decision making

Issues Identified by the Institute of Medicine

Delivering High-Quality Cancer Care: Charting a New Course for System in Crisis

Institute of Medicine September 2013

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Describe the CoC’s Continuum of Care Standard: Patient Navigation Process

Recognize the options for methodologies to use when implementing the Patient Navigation Process Standard

Identify the CoC’s Continuum of Care process requirements

Discuss how the CoC measures standard compliance

Learning Objectives for Today

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Continuum of Care Standards

Patient Navigation Process

Psychosocial Distress Screening

Survivorship Care Plan

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S 3.1 A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The navigation process is evaluated, documented, and reported to the cancer committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment.

Standard 3.1 Patient Navigation Process

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Prior to establishing the how you are going to help patients navigate barriers and facilitate access to

quality care, complete a community needs assessment

identify the needs of the population

determine potential to reduce cancer disparities

identify resources and address resource gaps

Patient Navigation Process

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repurposed without written permission of the American College of Surgeons.

Define Health Disparities

Identify Barriers to

Care

List Resources & Resource

Gaps

Community Needs Assessment

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without written permission of the American College of Surgeons.

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“A population is a health disparity population if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates in the population as compared to the health status of the general population.”

Minority Health and Health Disparities Research and Education Act United States Public Law 106-525 (2000), p. 2498

Define Health Disparities

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There are several factors that contribute to health disparities. Many different populations are affected by disparities including racial and ethnic minorities, residents of rural areas, women, children, the elderly, and persons with disabilities.

HHS-Office of Minority Health

Complex and interrelated factors contribute to the observed disparities in cancer incidence and death among racial, ethnic, and underserved groups. The most obvious factors are associated with a lack of health care coverage and low socioeconomic status.

National Cancer Institute

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25,770 - Estimated Number of New Cases10,130 – Estimated Number of Deaths

Cancer Facts & Figures 2014 American Cancer Society, Inc.

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Three Year Average State Poverty Rates: 2010 - 2012 (Current Population Survey, March 2011-2013)

State Rate

Louisiana 21.2

Mississippi 20.6

New Mexico 20.3

District of Columbia 19.3

Georgia 18.4

Arizona 18.3

Arkansas 18.0

Texas 17.6

South Carolina 17.5

Kentucky 17.2Tennessee 17.2

West Virginia 17.0

North Carolina 16.7

New York 16.4

California 16.4

Alabama 16.2

Oklahoma 16.1

Nevada 15.9

Indiana 15.7

Florida 15.4

Ohio 15.3

Missouri 15.2

United States 15.0 Un

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without written permission of the American College of Surgeons.

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©2014 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Friday, August 29, 2014

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Insurance Status by Race/Ethnicity of All Sites Cancer Diagnosed in 2011

All Diagnosed Cases - All Types Hospitals in State of Kentucky- Data from 31 Hospitals

InsuranceStatus

Race/Ethnicity Totals

White Black Hispanic Other/Unknown N %

1.NotInsured

716 106 27 3 852 4.38%

2.Private/Managed

6324 345 40 57 6766 34.75%

3. Medicaid 1198 165 18 13 1394 7.16%

4. Medicare 9090 523 22 51 9686 49.75%

5.OtherGovernment

571 88 6 9 674 3.46%

6.

InsuranceStatusUnknown

85 6 1 4 96 0.49%

TOTAL 17984 1233 114 137 19468 100%

©2014 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Friday, August 29, 2014

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Insurance Status of All Sites Cancer Diagnosed in 2011

All CoC programs – US

Not insured 4%

Private or managed 35%

Medicaid 7%

Medicare 50%

Other government 3%

Unknown 1%

Kentucky

Not insured 3%

Private or managed 41%

Medicaid 5%

Medicare 45%

Other government 3%

Unknown 3%

Not insured Black=9% compared to 4% WhiteMedicaid Black=13% compared to 7% White

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Define Health Disparities

Identify Barriers to

Care

List Resources & Resource

Gaps

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Identify Barriers to Care

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Internal

Organizational Assessment

The regular and systematic collection, analysis and dissemination of information on the performance of services offered and the health of the populations served, which enables health needs to be identified.

Dr. Richard H. Sewell

University of Illinois at Chicago

School of Public Health

External

Community Needs Assessment

A systematic set of procedures undertaken for the purpose of setting priorities and making decisions about programs or organizational improvements and allocation of resources.

Witkin & Altschuld

Planning and Conducting Needs Assessments: A Practical Guide, 1995.

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In a large study, 18% of respondents sited their reasons for unmet needs or delayed care in the previous 12 months were due to financial concerns or concerns about coverage.

Kullgren JT, et al. Nonfinancial barriers and access to care for US adults. Health Serv Res online, 2011.

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CostInsurance coverage TransportationLanguageLiteracy

Provider-Centered Barriers

Perceptions

Time constraints

Provider communication

Lack of familiarity or trust

Adequate supply of clinicians

Clinician gender or ethnicity

Clinician attitudes

Health System BarriersFragmented medical systemMissed appointmentsLost resultsSchedulingHours of operationClinic neighborhood

Patient-Centered Barriers

FamilyTime off workToo busyFearPerceptions & beliefs

Social supportComorbiditiesChildcareTravel timeHousingDisability

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Needs Assessment Methodology

Purpose-Issue-Scope

Target Group Resources Timeline

Patient & Provider Surveys

InterviewsFocus

GroupsTown Hall Meetings

Photos or Audio

Appropriate literacylevels

Information direct from

the consumer

Culturally appropriate

Stakeholder discussions

Appropriate for vulnerable

populations

Adapted from a presentation by Yolanda Suarez-Balcazar, PhD ; UIC

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Define Health Disparities

Identify Barriers to

Care

List Resources & Resource

Gaps

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Communication Resources

Legal Resources

Financial Navigation Resources

Outreach Navigation Resources

Diagnostic Navigation Resources

Treatment Navigation ResourcesSurvivorship, Rehabilitation & Supportive Care Resources

http://www.hpfreemanpni.org/resources/

Identify Resources and Resource Gaps

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Define Health

Disparities

Identify Barriers to

Care

List Resources

& Resource Gaps

Use results for program

development, implementation

& evaluation

Improved patient

outcomes

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1. Conduct a community needs assessment at least once during the three-year survey cycle to address health care disparities and barriers to care for patients.

2. Establish a patient navigation process and identify resources to address barriers that are provided either on site or by referral to community-based or national organizations.

3. Each year, barriers to care are assessed and the navigation process is evaluated, documented, and the findings are reported to the cancer committee.

4. Each year, the patient navigation process is modified or enhanced to address additional barriers identified by the community needs assessment.

CoC Compliance Measures

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The navigation process is evaluated, documented, and reported to the cancer committee annually.

The program completes the Survey Application Record (SAR).

The program provides a copy of the findings of the community needs assessment, evaluation, and report of the navigation process.

Documentation

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1. The community needs assessment must be done every three years, as currently codified in the Standards Manual. The cancer committee defines the scope of the community needs assessment and is encouraged to link with the outreach and or marketing department or community-based organizations outside of the facility to accomplish this task. The cancer committee needs to be involved in the design of the assessment and the evaluation of results. The cancer committee's activities are documented in cancer committee minutes.

Clarification to Standard – September, 2014 release

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2. The intent of the Standard is to identify and address a new barrier each year; however, programs are allowed to address the same barrier or disparity for more than one year as long as the following criteria are fulfilled:

A. The cancer committee determines that addressing the barrier is the most important concern for their patients.

B. The cancer committee documents in their minutes that they have put forth significant activity over the year, but that there is an ongoing need to continue addressing the barrier.

C. The current progress to address the barrier is reported to the cancer committee annually.

D. The cancer committee decides to continue work to address the barrier until the issue is resolved, for a period not to exceed the 3 years between CoC program surveys.

Clarification to Standard – September, 2014 release

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Improved rates of screening and follow-up

Lower clinical stage at presentation

Improvements in completion of treatments

Reported levels of increased psychosocial support

Higher patient satisfaction

Ability to engage, track, and support patients

Ability to develop communication and trust between clinics and disadvantaged populations

Increased enrollment and retention into clinical trials

Dohan & Schrag

Anticipated Patient Outcomes

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