DENVER, CO—Initial reactions to the 2012 Commission on Cancer (CoC) cancer program standards ranged from confused to frustrated to angry to baffled. But navigators have an arsenal of tools that can help them keep the cancer programs at their institutions in adherence to the CoC standards, explained Cindy Stern, RN, MSN, CCRP, a Commission on Cancer Survey consultant and senior administrator at Penn Cancer Network, in her presentation at the 2015 Oncology Nurse Advisor Navigation Summit.
CoC accreditation remains the only standards that address the IOM recommendations. “CoC takes compliance very, very seriously,” Stern said. The 2012 standards are a major attempt to ensure patient-centered care that uses community assessment-based care strategies and focuses on quality-driven care delivery. These objectives can be achieved with an effective community health needs assessment (CHNA).
Four CoC standards require a CHNA: community outreach (1.8), prevention program (4.1), screening program (4.2), and a patient navigation process (3.1). However, if you do this right, the CHNA will support navigation, prevention, screening, and community outreach.
An effective CHNA links to navigation activities, identifies outcome measures, and documents the program and its metrics. But Stern points the CHNA does not need to be a doctoral dissertation.
CHNA data is available from sources outside the institution (external) or sources specific to the institution (internal). One potential external view of the community is the Patient Protection and Affordable Care Act (PPACA), which requires not-for-profit hospitals to conduct a CHNA every 3 years. Although this data is a general assessment of all health needs of the community served by an institution, Stern explained, there is information in this report that can help characterize the oncology-specific challenges, barriers, and needs of the community. Another important source of data is the cancer committee minutes for your facility or institution.
Additional external views are available from national, state, and local sources such as the American Cancer Society; Surveillance, Epidemiology, & End Results (SEER) data; US Census Bureau; National Cancer Data Base (NCDB); Centers for Disease Control and Prevention (CDC); and the Cancer Control P.L.A.N.E.T. Local and state sources include cancer registries, marketing and/or business development departments, return on investment (ROIs) developed by administrators, public health departments, State Bureau of Health Statistics and Research, local or regional Chamber of Commerce, and cancer/health/underserved population organizations.
Internal views of patient populations define the community of patients as those receiving care at your institution by disease site, for example colorectal cancer, or by risk factors such as financial issues, multiple comorbidities, or age specific to your institution’s patient population. “No one navigation process is required to be the same as another navigation process,” Stern said.
Use institutional-based resources that could provide information on patient characteristics and/or gaps in services experienced by patients (eg, case volume, stage at diagnosis, screening rates, income and education levels, and medical staff).
The CoC does not expect cancer programs to address every disparity, barrier, or challenge to care. What CoC does want to see is when your facility successfully addresses a community need, move on to include the next disparity for your program.
Identify one specific patient population, using external and/or internal sources, and the challenges, barriers, and needs of that group. “But you need to document what you did in a way that speaks to CoC,” Stern advised. Make sure your cancer committee minutes document discussion of navigation, its community outreach, and prevention and screening programs. Navigators should use templates to document compliance with the standards for the CHNA, navigation processes, and community outreach. In addition, she advises navigators use available sources that have already compiled the information needed to support your program.