The cost of chronic illnesses in the United States has increased dramatically and the need to develop a cost-effective approach to improve the management of chronic disease among vulnerable populations is needed. Many of the health care reform initiatives have focused on the underserved and uninsured population through providing the right to health care, access, sustainability, and quality of care. Good health care is accessible, affordable, available, appropriate, and accountable. Patient navigation and the role of the nurse navigator are essential in facilitating good health care to the population they serve.
Many patients have difficulty accessing health care and navigating the complex system. Many times there are disparities and/or barriers to care such as language, culture, education level, level of trust in the health care system, and psycho-social needs, in addition to being in an underserved population.
Navigation is the process by which an assigned navigator assesses individual needs; plans for education, coordination, communication, and support; and implements effective transitions through the illness trajectory. In addition, the navigator should also evaluate the effect of the navigation process on the patient, family, and the organization’s outcomes. As with any model of care delivery the desired outcomes should be identified, measured, and evaluated. The navigation processes and services should reflect the strengths and desired results, as well as address the challenges of the community system and facility in which the navigation program resides.
The nurse navigator facilitates improved health care access and quality of care for the underserved/uninsured population, and bridges the gap through advocacy and care coordination. Currently, most navigators within cancer centers are professionals whose clinical nursing guides patients, families, and their caregivers to informed decision-making, collaborating with a multidisciplinary team to allow for timely cancer screening, diagnosis, treatment, and increased supportive care across the continuum.
Navigators play an integral role in health care reform and cost containment. Their involvement in patient care can reduce hospital admissions and/or re-admissions for the cancer patient. Additional areas of controlling health care cost are preventing delays in the diagnosis, staging, and treatment of the oncology patient in various oncology settings, and maintaining consistency in the care of the patient.
When a patient is navigated around the barriers to care, their ability to accept and remain in care is improved, leading to better adherence, potentially less treatment, improved quality of life, more diligent follow-up, and earlier detection of recurrence or complications of disease or treatment, precious health care dollars. When resources are allocated appropriately and used effectively, complications are minimized and outcomes are improved. This extends far beyond the single patient. The cost savings through the use of patient navigation ensure more money is available to research disease causes, detection, treatment, and prevention.
Sharon L. Francz is Executive Director and co-founder of the National Coalition of Oncology Nurse Navigators (NCONN).