Patient Care Connect
- Need: Cancer patients living in the Deep South encounter multiple barriers in accessing regular cancer treatment.
- Intervention: The University of Alabama at Birmingham Comprehensive Cancer Center developed a program that uses lay patient navigators to support and direct patients to appropriate resources to overcome barriers to accessing care.
- Results: The program has become a model for improving cancer care quality, decreasing unnecessary utilization (ER visits and hospitalizations), removing barriers to care, and enhancing patient satisfaction.
Effective (About evidence-level criteria)
A cancer diagnosis alone can create a unique set of challenges in getting regular treatments for patients living in rural areas. The Deep South (Alabama, Florida, Georgia, Mississippi, and Tennessee) experiences a higher rate of educational, social, and economic disparities that also contribute to the limitations in accessing medical care.
Established in 1971, the University of Alabama at Birmingham (UAB) Comprehensive Cancer Center is the only National Cancer Institute-designated Comprehensive Cancer Center covering a 4-state region in the Deep South. For many patients, the distance was too far to travel on a regular basis. To expand their reach, the UAB Health System Cancer Community Network was created as an avenue for cancer centers in Deep South states to collaborate with the UAB Comprehensive Cancer Center with the goal of improving the overall quality and availability of cancer services for these patients, closer to home.
With a 3-year Health Care Innovations Award (HCIA) from the Centers for Medicare & Medicaid Services, the UAB Comprehensive Cancer Center established a patient navigator program called the Patient Care Connect Program (PCCP). At each of the network’s associate sites, non-clinical lay navigators assisted with care coordination for Medicare patients, 65 years and older, with a confirmed cancer diagnosis. Many recipients lived in medically underserved areas, including both rural communities or inner cities.
The goal of the patient navigator is to empower patients to achieve their maximum health by offering support and direction to address barriers to care. The navigators empower their cancer patients and survivors to gain access to available resources while helping with coordinating care. They play a dual role as liaison between the patient and their medical team as well as an emotional support for the patient. Navigators provide assistance to the patients throughout the cancer continuum - from diagnosis, to treatment, survivorship, and end-of-life care if necessary.
Within PCCP, the minimum educational requirement for a patient navigator is a bachelor’s degree in any field of study. However, navigators are required to go through extensive training that focuses on basic concepts of navigation, communication and listening, health promotion, empowerment, and advanced care planning. The navigator is one of many supporting oncology care team members helping the oncologist and care team with the patient during their cancer journey.
Patient Care Connect is a program of the UAB Comprehensive Cancer Center of Birmingham, AL and was implemented at the following 12 associate sites:
- Southeast Alabama Medical Center - Dothan, AL
- Russell Medical Center - Alexander City, AL
- Northeast Alabama Regional Medical Center - Anniston, AL
- Gulf Coast Regional Medical Center - Panama City, FL
- Marshall Medical Centers - Boaz & Guntersville, AL
- Fort Walton Beach Medical Center - Fort Walton Beach, FL
- Singing River Health System - Pascagoula, MS
- CHI Memorial Hospital - Chattanooga, TN
- Northside Hospital - Atlanta, GA
- USA Mitchell Cancer Institute - Mobile, AL
- The Medical Center, Navicent Health - Macon, GA
- University of Alabama at Birmingham Medical Center - Birmingham, AL
Patient navigators offer the following services to Medicare cancer patients with a confirmed diagnosis of cancer:
- Conduct a periodic distress assessment using the NCCN Distress Thermometer tool that was modified with permission to address patient identified barriers to accessing care as well as patient reported health concerns.
- Assist patients with barrier resolutions such as securing transportation and lodging for extended care treatments, coordinating appointments, and providing additional resources for information concerns.
- Encourage lifestyle changes to improve quality of life by emphasizing age-appropriate screenings, healthy eating, tobacco-use cessation, and increased physical activity.
- Make follow-up calls after appointments to confirm patient understanding of “next-steps” or address any questions the patient may have.
- Offer ongoing availability and regular communication to patients via face to face meetings or phone calls.
- Offer assistance with identifying goals of care and a healthcare surrogate using the Respecting Choices model.
Patient Care Connect has become a model for improving cancer care quality, decreasing unnecessary hospitalization, and enhancing patient satisfaction. During the grant period, a total of about 40 professional navigators worked in a 5-state area. More detailed results can be found in the HCIA Disease-Specific Evaluation - Third Annual Report, but below are some of the results of their efforts:
- PCC has assisted over 10,000 patients since 2012
- Reduced the number of unnecessary hospitalizations, emergency department (ED) visits, and intensive care unit visits for patients enrolled in PCC
- Appropriate use of Hospice service increased
- Total medical costs saved for PCC patients estimated $17 million per the 2015 ASCO Annual Meeting
Insurance payers, including Medicare, have begun
exploring the idea of including navigator services in
their alternative payment models for reimbursements.
UAB has recently partnered with Guideway Care to expand capacities to provide navigation services beyond the UAB Health System Cancer Community Network.
Publications featuring Patient Care Connect:
- Rocque et al. (2016). Guiding Lay Navigation in Geriatric Patients With Cancer Using a Distress Assessment Tool. Journal of the National Comprehensive Cancer Network. 14(4), 407-14. Article Abstract
- Rocque et al. (2017). Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations. Journal of Pain and Symptom Management, 53(4), 682-692. Article Abstract
- Rocque et al. (2017). Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer. JAMA Oncology. 3(6), 817-825.
- Read more about PCC through a Q&A with Dr. Edward Partridge of the UAB Comprehensive Cancer Center.
- Many physicians, nurses and social workers were resistant to the program initially because they did not see the value of navigation services and were concerned with a non-clinical person talking to their patients about cancer care.
- PCC originally encountered resistance from both clinicians and the navigators regarding the navigator initiating Advanced Care Planning discussions with patients, following training and implementation of the Respecting Choices program.
- Lack of clarity and understanding of the patient navigator role created anxiety for other team members who viewed some of the navigator activities as very similar to their own, causing them concern for their job security.
Below are some steps that the UAB Comprehensive Cancer Center took that resulted in a wider acceptance of PCC in associate hospitals:
- Internal hiring of nurse site managers proved to be an advantage due to their understanding of the program and their pre-established relationships with clinical staff.
- The extensive amount of data monitoring and evaluation helped to build credibility among providers.
- Intentionally investigating and understanding a partnering hospital’s culture was key to successful integration of the program within a hospital’s existing system.
PCC navigators use the following tools administered by UAB:
- Medical Concierge, a web-based program which was revised and enhanced to capture and track all participant and navigation-related activities.
- Electronic health records systems to communicate with clinical staff.
- A custom-developed distress assessment tool as the “anchor” for the Navigator’s workflow.
- A custom-developed “Care Maps” outlining the protocols for handling specific patient reported barriers and/or issues.
Alabama, Florida, Georgia, Mississippi, Tennessee
September 6, 2016
December 18, 2017
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