Patient Navigator Improves Outcomes, Incomes

HealthLeaders Magazine , Janice Simmons, for HealthLeaders Magazine, February 4, 2010

Proactive engagement through patient navigators can improve outcomes and incomes.

Patient navigators can be found throughout hundreds of hospitals and cancer treatment facilities across the country—helping patients move throughout the organization to get the care that they need. But what if a patient wanted to use services outside of that organization? Oftentimes, that navigation can be difficult.

Recognizing this problem, a new idea is being tested in Washington, DC, using "network navigation." The purpose is to promote smooth navigation for breast cancer patients among any of what would be considered the five competing hospitals—plus several medical centers—in the city.

It's an effort to "break down the silos between the major hospitals and healthcare institutions in the city," explains Steven Patierno, PhD, executive director of George Washington University's Cancer Institute, which is coordinating the research effort.

The other organizations participating are Georgetown University Medical Center and Washington Hospital Center (operated by MedStar Health), Howard University Hospital, and Providence Hospital; several clinics also are participating, including Unity Health Care, which is operating in the facilities of what was once known as DC General Hospital.

This initiative, which started with a grant in 2005 from the National Cancer Institute, is designed to promote a "seamless transition from community outreach to screening to diagnosis to treatment," explains Patierno. So far, nearly 1,200 people have enrolled in the study.

In this initiative, for instance, a patient may receive a screening mammography at a clinic in the city; if a suspicious mass is indicated, the navigator with that clinic will contact the patient's hospital of choice in Washington, where that organization's patient navigator is notified. The patient then will be transitioned "seamlessly" to the hospital with the assistance of the latter patient navigator.

With these transitions, the group has been looking at whether patient navigation decreases the time between suspicious findings and diagnostic resolutions and between diagnosis and the onset of treatment. It is also examining whether patient navigation is helping patients overcome barriers such as fear, mistrust, transportation, financial issues, child care, and coping styles, Patierno says. Findings from this research will be released in a year or two.

Putting the network together required "a very directed and committed will," Patierno said. With GW taking the lead, "we put a lot of time and effort into going to each individual organization, meeting with the leaders, describing to them in detail the importance of the network, and the importance of it to the healthcare of our city."

"We found people within each organization who will be willing to lay down their competitiveness and find a means to cooperate. But I can't say it's been easy," Patierno says. For example, each hospital has its own institutional review board (IRB), with different levels of requirements and different levels of stringency.

"But in the end, we prevailed. People felt like it was the right thing to do—and I believe they continue to think it's the right thing to do," he says. "Does it take an enormous continued effort to maintain? Yes, it does. But we're committed to it, and I think that's the driving force." He notes it embodies the new term in business jargon called "competitivity." "It's where businesses—and I would say medical centers and hospitals, too—can function competitively . . . but can do it in a spirit of cooperation."

In a separate move, the GW Cancer Institute and GW's Department of Health Policy announced in 2009 the creation of the Center for the Advancement of Cancer Survivorship, Navigation, and Policy to train patient navigators at the local, regional, and eventually national level.

The goals of the center reflect some of the changes that patient navigation has been undergoing in recent years to improve quality of life for patients throughout the entire cancer experience—and to continue that process, according to Mandi Pratt Chapman, the center's codirector and director of GW Cancer Institute's Office of Survivorship.


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