The Community Health Needs Assessment: Building the Backbone of a Navigation Process

The Community Health Needs Assessment: Building the Backbone of a Navigation Process
The Community Health Needs Assessment: Building the Backbone of a Navigation Process

ORLANDO, Fla.—American College of Surgeons Commission on Cancer (CoC) accreditation ensures that facilities providing cancer care maintain standards that address multidisciplinary, comprehensive cancer care. This system is the only one “that provides the standards, data base, quality metrics and multidisciplinary focus that addresses the IOM recommendations,” said Cindy Stern, RN, MSN, CCRP, survey consultant, Commission on Cancer, and senior administrator at Penn Cancer Network at the 2nd Annual Oncology Nurse Advisor Navigation Summit.1

The CoC is a consortium of professional, advocacy, and health care organizations whose mission is to improve survival and quality of life for persons with cancer. “Only about 30% of health care organizations provide cancer care, but that 30% provides 70% of all the health care,” said Stern.

A navigation process that effectively addresses health care disparities and barriers to cancer care is driven by a triennial Community Health Needs Assessment (CHNA). If you do this right, your CHNA will meet the criteria that ensure your navigation process passes muster with the CoC, assured Stern.

A CHNA that meets CoC requirements includes identification of the cancer program's “community,” defined health disparities, descriptions of the barriers to care, a list resources available on-site or by formal referral, and metrics reports that demonstrate the navigation program's effects on the described barriers.

Community Identify the community or population served by the navigation process. For example, a disease site focus might identify the community as patients with head and neck cancer, with a high volume of these patients presenting with advanced stage disease.

Disparity Define the differences and inequalities that affect the community population. For example, these patients are predominantly older than 65 years with diminishing social supports, many are retirees on fixed or low incomes, and often present with a high level of comorbidities.

Barriers Describe the barriers that interfere with cancer care and differentiate between patient-centered (eg, financial, health literacy, high number of missed appointments, communication challenges), provider-centered (eg, communication, time constraints, no pathway), and health system-centered (eg, limited support personnel and resources, system fragmentation, provider access problematic).

Resources List resources needed to address the barriers, examples include care pathway development, coordination of multidisciplinary care needs and primary care, proactive assessment and referrals for support services, and alternative approaches for communication and provider access.

Metrics Use assessment methods and information sources, such as cancer registry data, readmission and emergency department review, quality review of adverse events and toxicities, patient and family surveys, and patient satisfaction data, to measure outcomes of the program (eg, increased screening rates, early stage disease at presentation, improved time from diagnosis to initiation of treatment).

A navigation process does not have to address multiple barriers all at once. Consider staggering rollout of barriers, strategies, and desired outcomes, Stern suggested. “The navigation process implemented will depend upon the particular type, severity, and/or complexity of the identified barriers.”


1. Stern C. Complying with the navigation requirements for the Commission on Cancer. Oral presentation at: Oncology Nurse Advisor Navigation Summit; April 7-9, 2016; Orlando, FL.

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