Navigation models in diverse outpatient settings: Shared themes, challenges, and opportunities.

Abstract

134 Background: Navigation has been recognized by the Centers for Medicare and Medicaid Services (CMS) as a component of quality oncology care. This discussion highlights progress of Nurse Navigation implementation within 3 US Oncology Network practices. A team-based approach optimizing patient care coordination and providing enhanced services has been identified. Study practices demonstrate common navigation goals and desired outcomes, despite variations in practice size, dissimilar workflows, and unclear best-practice guidelines for navigation in the outpatient setting. Methods: The US Oncology Network formed a committee to study and develop evidence-based nurse navigation processes for recommendation to the greater Network. The committee includes 6 members, each a lead Oncology Nurse Navigator, practicing in different US geographical regions. Preliminary steps were to seek evidence-based support through: Existing models for Oncology Nurse Navigation that are adaptable for the community setting Best-practice in navigation recommendations from esteemed professional organizations Challenges and solutions identified and implemented Scope of practice for the Nurse Navigator in a community setting Performance metrics targeting effective, value-driven navigation Results: Focusing on scientific Nursing Process, study practices provided navigation services to 3762 patients. Gaps in navigation processes were identified, as well as barriers throughout the continuum of care. Scope of Practice for the community-based Nurse Navigator was defined. Navigation framework was established to include patient/family education, psychosocial interventions, referral outsourcing, and patient advocacy. A formal job description was created for the role of the Oncology Nurse Navigator. The Interdisciplinary Care Team Conference Standard was finalized to support coordination of care. Conclusions: Work remains to define, implement, and test effective navigational models to support challenges of patients receiving care in the outpatient setting. Benefits resulting from Nurse Navigation processes are emerging as healthcare trends advance quality of care while decreasing total cost of care.