Transcript Abella_11am - Wisconsin Comprehensive Cancer Control

We Help People Live Well
Aurora Health Care’s
Cancer Nurse
Navigator Program
Delivers on Patient and
Family Centered Care
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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
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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.
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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
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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
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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
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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
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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)
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Care for the mind.. body… spirit…
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6500 DT
April-December
2011
84
69
72
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364
389
231
500
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100
35
100
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134
285
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86
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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
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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
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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.
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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
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4
Q4:Q4:The CNN
listened to my
The CNN listened to
family’s
my family’s
concerns.
concerns.
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Q5:The CNN
Q5:
demonstrated
The CNN
concern for
demonstrated
my emotional
concern for my
well being.
emotional well
being.
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Q6:The CNN
Q6:
was
The
CNN was
compassionate.
compassionate.
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Q7:The CNN
Q7:
was available
The CNN was
to me
available to me
throughout
throughout my
my cancer
cancer
experience.
experience.
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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
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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
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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
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Our Journey Continues
“Perfection is not attainable.
But if we chase perfection,
we can catch excellence.”
Coach Vince Lombardi
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Thank you for your interest!
Further information contact:
[email protected]
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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.
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