Integration of an Asthma Navigator Improves Access to New Therapies

Abstract

SESSION TITLE: Allergy and Asthma SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Access to new therapies is challenging. Nurse navigators are common in complex care delivery. Understanding comprehensive asthma care and the intent of improving access to new therapies, we created an Asthma Navigator (AN) role to optimize resources and patient education. Our hypothesis was that increasing one-on-one education to appropriately screened patients would improve their understanding of advanced treatment for severe asthma, in this case, Bronchial Thermoplasty (BT). Our pilot was a collaboration between industry and community-based practice. METHODS: In Phase 0, 1, and 2, patient selection criteria for BT candidates included nationally accepted criteria1. Phase 0 (Retrospective): Analysis of the number of BT-related encounters in the same 16-week period in the prior year to allow for seasonal variability. BT program was well established. Phase 1 (Retrospective): Identified severe asthmatics through an EMR search (288 charts reviewed) of preceding 8 weeks. Contacted patients to discuss their severe asthma management and introduce BT. Patients were given the option to schedule a BT evaluation. Phase 2 (Prospective): During the second 8-week phase, AN reviewed the clinic schedule and medical records two-weeks in advance and flagged potential patients for physician input at the time of visit. RESULTS: Phase 0: 3 patients evaluated and/or treated. Phase 1: Of 288 charts, 17 were severe asthmatics who met BT screening criteria. This process was time-consuming (approx. 30-minutes per record review and 10-minutes to educate, schedule the BT evaluation). 88% of patients (15/17) who spoke with the AN agreed to BT evaluation. 35% of EMR search output (103/288) contained duplicate records or missing information that limited the ability to perform a comprehensive screening. Phase 2: During the second 8-week phase, there was a 71% increase (from 7 to 12) in the number of pre-qualified patients referred for BT evaluation. There was an 83% increase (from 6 to 11) in the number of patients who were formally educated by the AN while in office and a 75% increase (from 4 to 7) in the number of patients who entered the pre-authorization process with AN support. The result, a 50 % increase (from 4 to 6) in the number of patients approved and treated with BT during the pilot phases. There were improvements in each category and both improved compared to baseline. Formal education was given to 50 patients (29 phase 1; 21 phase 2) with 31 BT evaluations (10 phase 1; 21 phase 2) conducted. Patient interest, insurance approval, and subsequent treatment with BT increased with the use of the AN (10 patients in treatment during the study compared to 3 patients during the same time in prior year). CONCLUSIONS: As further therapies such as BT continue to develop, the integration of an Asthma Navigator (AN) is an effective model for increasing patient education. Although studied for BT, the AN model can be applied more globally to asthma management. CLINICAL IMPLICATIONS: The use of navigators in complex patient management can optimize access and efficiency, and their use should be considered beyond traditional spheres DISCLOSURE: Katy Roesner: Grant monies (from industry related sources): Supported as navigator during the study Diana Walsh: Employee: Employed by Boston Scientific Tony Vari: Employee: Boston Scientific The following authors have nothing to disclose: Neeraj Desai, Kim French, Kevin Kovitz No Product/Research Disclosure Information