Use Outcomes and Metrics to Improve Navigation Strategies
ONS member Judy B. Koutlas RN, MS, OCN®, manager of oncology navigation at Vidant Medical Center in Greenville, NC, discussed best practices and metrics related to navigation programs to improve nursing performance and patient quality of care during a session at the Oncology Nurse Advisor Navigation Summit (http://media.oncologynurseadvisor.com/documents/303/ona_navsum_2017_koutlas-webver_75661.pdf).
With a review of the literature, Koutlas noted some gaps in research regarding patient navigation, including lack of evidence-based metrics to decrease mortality and information on long-term outcomes, lack of proven economic impact, specific outcomes measures along the care continuum, and limited research on lay versus nursing navigation models.
Outcome metrics include patient reported (experience, transitions of care), clinical (evidence-based practice, education, timeliness, compliance, guidelines), and business/return on investment (downstream revenue, cost savings).
She said that programs still need to make decisions such as:
- Choosing the “right metrics”
- Number of metrics
- Length of tracking
- Data collection
- Stakeholder and administrator input.
At Vidant, Koutlas said their choices for 2016 outcome measures included:
- Increase in patient volumes and coordinated care
- Care closer to home
- Patient and physician satisfaction
- Increase in patient recruitment, retention, and direct referrals
- Decrease in emergency department visits and readmissions.
She described the Vidant Cancer Care Acuity Tool that organizes patients based on need for navigation services, with a score of zero representing no need for navigation services, one needing up to 10 minutes of services, two needing more than 11 minutes but less than 45 minutes of services, and three needing more than 46 minutes of services with more complicated coordination of care.
She showed the navigation intervention form in Vidant’s system, which includes data that is autopopulated (i.e., name, medical record number, gender, age, race, county, insurance, and navigator) and selected by the navigator (i.e., type of visit, location of visit, referral source, diagnosis, barriers/needs, interventions/referrals, home situation, acuity scale, and continuum of care).
Looking to the future, Koutlas discussed outcomes that could be improved, such as standardized data collection practices, a national database, and the ability to analyze data in multidisciplinary teams across the healthcare system. Althought the task seems daunting, she said she believes that standardization of metrics is possible.