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We Help People Live Well Aurora Health Care’s Cancer Nurse Navigator Program Delivers on Patient and Family Centered Care Aurora Cancer Care 1 In Our Journey to Patient Centered Care Special Recognition: Vince Lombardi Cancer Foundation for their generous and ongoing support of this program Jean McDonald, RN, MSN Marija Weidman, RN, MSN Kristine Kwekkeboom, PhD, RN Associate Professor, UW-Madison School of Nursing Sandra Ward, PhD, RN, FAAN Helen Denne Schulte Professor Emerita Aurora Cancer Care 2 Delivering on Patient Centered Care: Cancer Nurse Navigator Framework Education & Outreach Psychosocial Cancer Nurse Navigators Facilitate Patient & Family Empowerment Continuity of Care Advocacy Overcome Individualized Barriers © 2011 Aurora Health Care, Inc. Aurora Cancer Care 3 Aurora Cancer Care 3 Your Life Changes Forever Three Words….. You have cancer….. • Cancer does not discriminate • Patients experience a high level of anxiety, fear and uncertainty, a sense of helplessness, feeling overwhelmed & lost • Cancer is a complex and scary disease - Patients see multiple physicians to determine their treatment plan - Treatment plans can include, surgery, radiation, and/or chemotherapy depending upon the diagnosis - Patients listen, but most often don’t hear what is being said • Resulting in confusion, lack of understanding • Not always comfortable asking physicians to clarify • Patients & families want answers immediately to know what lies ahead of them Aurora Cancer Care 4 Aurora Health Care’s Cancer Nurse Navigation Program Every patient deserves the best care • 24 Cancer Nurse Navigators (CNN’s) across AHC - Disease focused and generalists - 2011 57% patients connected with CNN • 29,400 patient contacts • Single standard of practice for CNN’s - Evidence based nursing clinical pathway - Job description, standards, educational preparation & certification - Documentation expectations • CNN web based database, real time data • CNN system patient satisfaction survey • Outcomes defined to measure impact Aurora Cancer Care 5 Aurora Health Care’s Cancer Nurse Navigators Offering Hope and Healing Every patient deserves the best care • Cancer Nurse Navigators - Partner with patients and families… • With compassion and concern to offer support, actively listen, and provide reassurance • Advocate for the unique needs of each patient to assure all care needs are met • Educate patients regarding cancer diagnosis, treatment options, research, support patient in decision making, engaging them in care planning • Support patient/family to be engaged and part of the decision making team Aurora Cancer Care 6 Aurora Health Care’s Cancer Nurse Navigators Offering Hope and Healing (cont’d) Every patient deserves the best care Cancer Nurse Navigators • Assess & Manage psychosocial distress, anxiety, fears • Help to “normalize” this very frightening time • Coordinate referrals to support services • Coordinate Continuity of Care • Timely access to care, minimize delays • Reduce duplication, unnecessary tests, diagnostics • Serve as a liaison with the Multidisciplinary team to minimize communication gaps • Seamless, smooth handoffs amongst care team • Identify and minimize barriers to care • Financial, transportation, family dynamics • Support patient and family throughout diagnosis, survivorship, EOL care Aurora Cancer Care 7 Cancer Nurse Navigation Program Defined Outcome Measurement • QOL - Screening Tools • Appropriateness of Care - Successful management of treatment toxicity Improved patient compliance through education Improved enrollment into clinical trials Timeliness of care • Patient Satisfaction • Physician Satisfaction and Productivity (expected shortage of medical oncologists) Aurora Cancer Care 8 Care for the mind.. body… spirit… 13 45 186 70 138 30 6500 DT April-December 2011 84 69 72 10 171 364 389 231 500 101 51 92 33 100 35 100 63 134 285 76 13 86 51 119 34 63 55 188 23 87 159 101 15 Aurora Cancer Care 9 Helping Patients and Families Live Well Clinical and Service Excellence Med/Surg Provider 234 Genetic Counselor 192 Psychological Cancer Counseling 192 Dietician 138 Survivorship Care 171 Cancer Rehab 122 Financial Assistance 100 Lymphedema Clinic 41 Second Opinion 31 Smoking Cessation 27 Support Groups 669 Community Services 467 Social Services 309 Spiritual Care 85 Advanced Directive Planning 34 Palliative Care 5 Hospice Care 11 Data collection began 12/2011 System CNN referrals ( 24 RNs) Timeframe 1/2011 12/ 2011 Aurora Cancer Care 10 2011 YTD Q1-Q3 CNN Satisfaction Results 5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00 1 Q1: Q1:The CNN provided The CNN information provided about my plan information of care based about my plan of on my needs. care based on my needs. Q2: Q2:The CNN helped me to The CNN helped understand me to understand my diagnosis my diagnosis and and treatment treatment options. options. 2 Q3:Q3:The CNN communicated/ The CNN coordinated communicated/ my care plan coordinated my with my entire care plan with care team my entire care team 3 4 Q4:Q4:The CNN listened to my The CNN listened to family’s my family’s concerns. concerns. 5 Q5:The CNN Q5: demonstrated The CNN concern for demonstrated my emotional concern for my well being. emotional well being. 6 Q6:The CNN Q6: was The CNN was compassionate. compassionate. 7 Q7:The CNN Q7: was available The CNN was to me available to me throughout throughout my my cancer cancer experience. experience. 8 Q8:I would Q8: recommend I would the CNN recommend the program to CNN program to my family and my family and friends. friends. 66% response rate Aurora Cancer Care Our work continues “Randomized trials are critical to … evaluate much more expensive and time-consuming commonsense ideas such as patient navigators, for which there were few data and no definitive randomized trials before widespread adoption.” Thomas J. Smith, The Sidney Kimmel Comprehensive Cancer Center at John Hopkins, Baltimore, MD Claire Snyder, John Hopkins School of Medicine and the Sydney Kimmel Comprehensive Cancer Center, John Hopkins, Baltimore, MD Is It Time for (Survivorship Care) Plan B, Journal of Clinical Oncology, 12.19.2011 Aurora Cancer Care 12 Cancer Nurse Navigator Pilot Study Demonstrating the Evidence • Purpose of this pilot study - Assess feasibility of studying the efficacy of Aurora Cancer Nurse Navigator program - Estimate the effects of cancer nurse navigator services on patient-reported outcomes and indicators of quality care • 2-group (usual care vs. usual care + CNN) randomized controlled trial - Up to 250 adult patients newly diagnosed or recurrence of breast, lung, colorectal, prostate or renal cancer receiving care at select sites Aurora Cancer Care 13 Our Journey Continues “Perfection is not attainable. But if we chase perfection, we can catch excellence.” Coach Vince Lombardi Aurora Cancer Care 14 Thank you for your interest! Further information contact: [email protected] 15 Aurora Cancer Care 15 References • Clark, M. (2010). Facilitating Best in Class Patient Activation [PowerPoint slides]. The Advisory Board Company. • Devers, K., Berenson, R.,(2009). Can accountable care organizations improve the value of health care by solving the cost and quality quandaries? Robert Wood Johnson Foundation. (p. 1-13). • Ferris, L.W, Farber, M, Guidi, T.U, & Laffey, W.J. (2010). Impact of health care reform on the cancer patient. The Cancer Journal 16,(6) p. 600-605. • Microsoft. (2007). Clipart. Retrieved March 22nd 2010 from http://office.microsoft.com/en-us/clipart/default. • Summary of New Health Reform law. Retrieved: http://kff.org/com • Schickendanz, A. (2009). Assessing and improving value in cancer care. Washington, D.C.: Institute Of Medicine. • Sg2 (2011). Accountable Care Resource Kit. Retrieved: www.sg2.com. 16 Aurora Cancer Care 16