Innovations in Models of Care Delivery

Transcription

1 Innovations in Models of Care Delivery Margaret Barton-Burke, PhD, RN, FAAN President, Oncology Nursing Society Mary Ann Lee Professor of Oncology Nursing University of Missouri St. Louis Research Scientist St. Louis, MO, USA

2 Special Thanks Jean B. Sellers, RN, MSN ONS SIG Coordinator, Nurse Navigation Cyndi Cantril, RN, OCN, MPH & Sharon Francz Co-Founders NCONN

3 Oncology Care Coordination Case Manager Guided Care Nurse ($$$) Oncology Care Coordinator Bone Marrow Stem Cell Transplant Coordination Patient Navigator Pivot Nurse (Canada) Advanced Practice Nurse CNS

4 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

5 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

6 Patient Navigation Across The Health Care Continuum PATIENT NAVIGATION Outreach Abnormal Results Diagnosis Treatment Rehabilitation Early Detection Education Screening 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 nonclinical lay patient navigator Survivorship Quality of Life Surveillance Prevention Diagnosis Treatment Post-Treatment Survival & Mortality (Freeman & Rodriguez, 2011; ONS, 2010)

7 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

8 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 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 members 2012 ONS develops ONN Core Competencies outlining knowledge & skills novice ONN should possess

9 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

10 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 Desimini et al, 2011; Fillion et al, 2013 De Desimini et., 2011; Fillion et al., 2012

11 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.

12 CORE COMPETENCIES Professional Role Education Care Coordination Patient Navigator General knowledge of disease, healthcare facility, community General knowledge of health promotion, cancer prevention & how to address nonclinical barriers to care Acts as liaison for community resources & healthcare system Oncology Nurse Navigator Clinical knowledge of disease process Assess educational needs & clinical barriers to patient care Provides disease specific information & symptom management 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

13 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

14 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), 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), 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 Pittsburg, PA: Oncology Nursing Society Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21 st 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, 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 Oncology Nursing Society. (2013). Oncology Nursing Society nurse navigator competencies. Retrieved from Pedersen, A & Hack, T (2011). The British Columbia Patient Navigation Model: A critical analysis. Oncology Nursing Forum, 38, Wilcox B & Bruce, S (2010). Patient navigation: A win-win for all involved. Oncology Nursing Forum, 27,21-25.