Innovations in Models of Care Delivery

Margaret Barton-Burke, PhD, RN, FAAN President, Oncology Nursing Society

2014-2016 Mary Ann Lee Professor of Oncology Nursing

University of Missouri St. Louis Research Scientist St. Louis, MO, USA

Special Thanks Jean B. Sellers, RN, MSN

ONS SIG Coordinator, Nurse Navigation

Cyndi Cantril, RN, OCN, MPH & Sharon Francz                                                               Co-Founders NCONN

Oncology Care Coordination

•  Advanced Practice Nurse

•  CNS

•  Patient Navigator

•  Pivot Nurse (Canada)

•  Coordinator

•  Bone Marrow

•  Stem Cell Transplant

•  Case Manager

•  Guided Care Nurse ($$$) Oncology Care

Coordination

Patient Navigation �  Developed Dr. Harold Freeman, (founder of Patient

Navigation) in 1990 means saving lives by eliminating barriers to care

Barriers to Care

•  Financial barriers, such as no health insurance

•  Communication & information barriers

•  Medical system barriers

•  Fear, distrust, and emotional barriers

Freeman & Rodrigues, 2011

Principles of Patient Navigation

�  Patient navigation promotes timely movement through the healthcare continuum.

�  Patient navigation integrates a fragmented healthcare system for the patient.

�  The core function of patient navigation is the elimination of barriers to care to timely care across all segments of the continuum.

�  Patient navigation should be determined by the level of skills necessary to navigate an individual.

Freeman & Rodrigues, 2011

PATIENT NAVIGATION

Early Detection

Quality of Life

► Focus on racial/ethnic minorities; medically underserved populations

► Integrate fragmented health care systems

► Elimination of barriers to care to ensure delivery of care

► Patient navigation may be delivered by a clinical or non-clinical lay patient navigator

Outreach Abnormal Results Diagnosis Treatment Rehabilitation

Education

Screening

Survivorship

Surveillance

(Freeman & Rodriguez, 2011; ONS, 2010)

Patient Navigation Across The Health Care Continuum

Prevention Diagnosis Treatment Post-Treatment Survival & Mortality

Patient Navigator Roles Professional Navigator

�  Oncology Nurse

�  Social Worker

�  Physician Assistant

�  Advanced Practice Nurse

�  Case Manager

�  Patient Care Coordinator

Lay Navigator

�  Volunteer Lay Patient Navigator

�  Patient Navigator

�  Lay Health Advisors

�  ACA exchange or market place navigator

�  Community Health Worker

Wilcox & Bruce, 2010; Pedersen & Hack, 2010; Lorhan et al, 2013

Oncology Nurse Navigator

�  2009 Think Tank on Patient Navigation involving ONS, AOSW & National Association of Social Workers, position paper on role of oncology nursing & social work in patient navigation released http://www.ons.org/publication/Positions/Navigation

�  Paper noted navigation services can be delegated to trained non-professional &/or volunteers & should be supervised by nurses or social workers

�  2010 ONS Nurse Navigator SIG is formed - 2000 members

�  2012 ONS develops ONN Core Competencies outlining knowledge & skills novice ONN should possess http://www.ons.org/sites/default/files/ONNCompetencies_rev.pdf

First textbook on Oncology Nurse

Navigation •  July 2014 ONS publishes

first textbook focusing on role of ONN

•  Provides an in-depth review of emerging specialty of ONN

•  Includes concrete examples, tangible tools, national & community resources

ONN Professional Practice Framework

�  Promotes key processes & relationships that influence role of ONN & desired outcome

�  Identifies role of ONN in bi-dimensional framework: organization & patient

�  Organization refers to healthcare system

�  Patient corresponds to patient-centered care

De

Desimini et., 2011; Fillion et al., 2012

Desimini et al, 2011; Fillion et al, 2013

Importance of Competencies

�  Safe, effective & knowledgeable patient care most important reason for nurse competencies

�  Institute of Medicine (IOM, 2003) defines professional competence as “the habitual & judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values & reflection in daily practice for benefit of individual & community served.”

CORE COMPETENCIES

Patient Navigator Oncology Nurse Navigator

Professional Role General knowledge of disease, healthcare facility, community

Clinical knowledge of disease process

Education General knowledge of health promotion, cancer prevention & how to address non-clinical barriers to care

Assess educational needs & clinical barriers to patient care Provides disease specific information & symptom management

Care Coordination Acts as liaison for community resources & healthcare system

Ensure patient needs are met across all settings & facilitates delivery of quality care & improved outcomes

Communication Facilitates communication between ONN & patient

Facilitates communication with all members of health care team Provides psychosocial support

ONS Nurse Navigator Core Competencies, 2012; Gentry & Sellers, 2014

Future Direction �  ONS NN SIG need for

national education oncology nurse navigation program & certificate

�  Initial discussion at ONS Leadership Workshop with SIG leadership

�  Need Evidence & Outcomes: �  patient satisfaction �  improved interdisciplinary

communication

�  patient retention �  downstream revenues

References �  Desimini, E, Kennedy, J, Helsley, M, Shiner, K, Denton, C, Rice, t…..Lewis, M. (2011). Making the case for nurse navigators: Benefits,

outcomes, and return on investment. Oncology Issues, 26(5), 26-33. Retrieved from htt://accc-cancer.org/oncology_issues/articles/SeptOct2011?SO11-Desimini.pdf

�  Fillion, L, Cook, S, Veillette, A., Aubine, M., deSerres, M., Rainville, F.,….Doll, R. (2012). Professional navigation framework: Elaboration and validation in a Canadian context. Oncology Nursing Forum, 39, E58-E69.

�  Freeman H & Rodriguez B (2011) History & principles of patient navigation. Cancer,11,7(Suppl.15),3539-3542.

�  Gentry, S & Sellers, J. (2014) Navigation considerations when working with patients.  In Blaseg, Daugherty and Gamblin (Eds). Oncology Nurse Navigation: Delivering patient-centered care across the continuum. pp 71-120.    Pittsburg, PA:  Oncology Nursing Society

�  Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC. National Academies Press

�  Institute of Medicine (2010). The future of nursing: Leading change, advancing health: Washington, DC. National Academy of Sciences

�  Lorhan, S., Cleghorn, L., Fitch, M. et al (2013). Moving the agenda forward for cancer patient navigation: understanding volunteer and peer navigation approaches. Journal of Cancer Education, 28, 84-91.

�  Oncology Nursing Society. (2010b, March). Oncology Nursing Society, the Association of Oncology Social Work, and the National Association of Social Workers joint position on the role of oncology nursing and oncology social work in patient navigation. Retrieved from http://

�  Oncology Nursing Society. (2013). Oncology Nursing Society nurse navigator competencies. Retrieved from http://

�  Pedersen, A & Hack, T (2011). The British Columbia Patient Navigation Model: A critical analysis. Oncology Nursing Forum, 38, 200-206.

�  Wilcox B & Bruce, S (2010). Patient navigation: A “win-win” for all involved. Oncology Nursing Forum, 27,21-25.