scholarly journals Implementation factors for patient navigation program success: a qualitative study

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Mandi L. Pratt-Chapman ◽  
Rachel Silber ◽  
Jeffrey Tang ◽  
Phuong Thao D. Le
Keyword(s):  
Cancer Care ◽  
Patient Navigation ◽  
Relative Advantage ◽  
Structured Interviews ◽  
Healthcare Organizations ◽  
Staff Support ◽  
Program Success ◽  
Navigation Program ◽  
The Usa ◽  
Implementation Factors

Abstract Background Patient navigation (PN) is an evidence-based practice that involves assessing and addressing individual barriers to care for patients. While PN has shown effectiveness in numerous studies, designing successful, sustainable PN programs has remained challenging for many healthcare organizations. The purpose of the present study was to examine implementation factors for successful PN programs to optimize the sustainability of PN services across cancer care settings in the USA. Methods Data were collected via semi-structured interviews with PN stakeholders (n=17) from diverse cancer care settings. Thematic content analysis was conducted by deductively coding major themes based on constructs from the Exploration-Preparation-Implementation-Sustainability framework and by inductively coding emergent themes. Results Facilitators in the outer context included payer guidelines, accreditation requirements, community partnerships, and demonstrated need and demand for services. Inner context factors such as alignment with organizational and leadership priorities, appropriate staff support and workloads, and relative advantage were important to program success. Innovation characteristics such as the presence of innovation champions, clear role and scope of practice, clear protocols, strong communication channels, and innovation fit were facilitators of program success. Community-Academic partnerships and funding stability also emerged as facilitators for program sustainability. Conclusion Our qualitative analysis from a diverse sample of PN stakeholders and programs across the USA supports intentional use of implementation theory to design PN programs to optimize implementation success.

Abstract C09: A Patient Navigation Program in Mexico City as a model for overcoming barriers to accessing cancer care in Latin America

2017 ◽  
Author(s):  
Yanin Chavarri Guerra ◽  
Enrique Soto Perez de Celis ◽  
Wendy A. Ramos Lopez ◽  
Alexandra Bukowski ◽  
Sandra San Miguel ◽  
...  
Keyword(s):  
Latin America ◽  
Mexico City ◽  
Cancer Care ◽  
Patient Navigation ◽  
Navigation Program

scholarly journals The Development of Cancer Patient Navigation Program in Taiwan

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 243s-243s
Author(s):  
C.-W. Huang ◽  
C.-Y. Wu ◽  
R. Chen ◽  
T.-H. Huang ◽  
T.-H. Hsu ◽  
...  
Keyword(s):  
Survival Rate ◽  
Case Management ◽  
Cancer Treatment ◽  
Cancer Diagnosis ◽  
Cancer Care ◽  
Patient Navigation ◽  
Relative Survival ◽  
Relative Survival Rate ◽  
Navigation Program ◽  
Cancer Patient Navigation

Background and context: Cancer has been the leading cause of death since 1982 in Taiwan. Taiwan cancer case management program started from major 4 cancers (breast cancer, liver cancer, colorectal cancer, oral cancer) since 2004. However, only 82% of patients with a confirmed cancer diagnosis received their first cancer treatment within 3 months in 2012. Aim: To increase the navigation coverage for all cancer patients, Health Promotion Administration (HPA) sets the goal that 91% of patients with a confirmed cancer diagnosis should receive their first cancer treatment within 3 months in 2018. Strategy/Tactics: (1) Subsidize cancer hospitals (2) Accreditation for oncology case management (3) Pay for performance (P4P) Program/Policy process: We subsidized hospitals to establish oncology case manager since 2004. Gradually, hospitals in Taiwan accept this new nursing role and recognize its positive impacts on cancer care. Moreover, Taiwan Accreditation Program of Cancer Care mandated all cancer care institutes to establish the program for oncology case management since 2010. However, there were only 4-6 major cancer patients got the case management service. Thus HPA launched P4P Cancer Patient Navigation Program in 2014 and established reporting system. Outcomes: 95% of newly cancer diagnosis patients (including 92 hospitals) in Taiwan receive the service and 96% of patients with a confirmed cancer diagnosis receive their first cancer treatment within 3 months in 2017. Through the implementation of subsidy, accreditation and P4P, the relative survival rate showed significant improved. The 5-year relative survival rate for all cancers increases from 49% during 2003-2007% to 55.8% during 2011-2015. What was learned: A successful program might start small from few trial sites, should be fully supported and well established the systems by government and will move fast by all healthcare professionals.

scholarly journals De-implementing Low-Value Care in Cancer Care Delivery: A Systematic Review

2021 ◽  
Author(s):  
Amir Alishahi Tabriz ◽  
Kea Turner ◽  
Alecia Clary ◽  
Young-Rock Hong ◽  
Oliver T Nguyen ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Assessment Tools ◽  
System Level ◽  
Future Research ◽  
Unintended Effects ◽  
Inclusion Criteria ◽  
Framework Analysis ◽  
Healthcare Organizations ◽  
The Usa

Abstract Background Accumulating evidence suggests that interventions to de-implement low-value services are urgently needed. While medical societies and educational campaigns such as Choosing Wisely have developed several guidelines and recommendations pertaining to low-value care, little is known about interventions that exist to de-implement low-value care in oncology settings. We conducted this review to summarize the literature on interventions to de-implement low-value care in oncology settings, define an agenda for future research, and inform the literature about opportunities for additional work. Methods We systematically reviewed the published literature in PubMed, Embase, CINAHL Plus, and Scopus. We screened the retrieved abstracts for eligibility against inclusion criteria and conducted a full-text review of all eligible studies on de-implementation interventions in cancer care delivery. We used the framework analysis approach to summarize included studies' key characteristics including design; outcome(s); type of cancer, objective(s); and de-implementation interventions, determinants of the use ofthe use of de-implementation interventions, and their effectiveness. We assessed included studies’ quality using the NIH Quality Assessment Tools. Results Out of 2,793 studies, 13 met our inclusion criteria. Included studies have been published between 2003 and 2020, and the majority (n = 9) of them were conducted in the USA. They covered several cancer types including prostate cancer (n = 4), multiple cancers (n = 3), hematologic cancers (n = 3), lung cancer (n = 1), breast cancer (n = 1), and gastrointestinal cancer (n = 1). Four studies were focused on de-implementing low-value diagnostic tests, six studies focused on de-implementing low-value treatment procedures, and three studies focused on low-value screening services. Most of the de-implementation interventions (n = 11) were effective in reducing low-value care. No study assessed the determinants of the use of de-implementation interventions. Conclusions This review showed that to accelerate the reduction of low-value cancer care, instead of solely relying on diffusion new evidence and guidelines (i.e., passive de-implementation), healthcare organizations should initiate de-implementation interventions and implement strategies purposefully aimed at reducing low-value care (i.e., active de-implementation). Additionally, future research should include a broader range of variables such as patients’ perspectives and preferences, unintended effects of de-implementing low-value care, and system-level factors when studying de-implementation.

scholarly journals Impact of a Patient Navigator on Time to Diagnosis Among Pediatric Oncology Patients in Tanzania

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 1s-1s
Author(s):  
Fatima Alvi ◽  
Judy Mafwimbo ◽  
Kathryn McHenry ◽  
Nestory Masalu ◽  
Kristin Schroeder
Keyword(s):  
Pediatric Oncology ◽  
Pediatric Cancer ◽  
Cancer Care ◽  
Patient Navigation ◽  
Patient Navigator ◽  
Oncology Patients ◽  
Bugando Medical ◽  
Time To Diagnosis ◽  
Navigation Program ◽  
Bugando Medical Centre

Abstract 12 Background: Oncology patient navigation programs have been successfully implemented at hospitals throughout the United States and have enhanced the quality of care through financial guidance, treatment coordination, and psychosocial support. In low-resource settings, barriers to receiving cancer care are increased and a patient navigator in this setting has the potential to significantly impact outcomes; however, there is limited research on the efficacy of such programs in these settings. At Bugando Medical Centre in Mwanza, Tanzania, a patient navigation program was established to identify potential pediatric oncology patients, then assist these patients and their families throughout the diagnosis and treatment process with the goals of reducing time to oncology evaluation and diagnosis and, ultimately, improving survival outcomes. Methods: A retrospective analysis of hospital records was conducted of all pediatric oncology patients who were evaluated at Bugando Medical Centre from 2010 to 2016, separated by presentation date before or after establishment of the navigation program. Collected data include demographics, diagnosis, and time from presentation to oncology evaluation and diagnosis. Results: A total of 238 patient files were reviewed, with 169 patients pre- and 69 patients postprogram initiation. Patient groups did not differ by age or gender ( P = .329 and .744, respectively) or diagnosis distribution. After establishing a patient navigator program, average time to oncology evaluation decreased from 49.7 days to 16.6 days ( P = .015), and time to diagnosis decreased from 49.1 days to 23.6 days ( P = .07). Conclusion: In pediatric cancer, early diagnosis is critical for initiation of chemotherapy and improvement of outcomes. This study has shown that a patient navigation program has the potential to significantly impact patient outcomes through reductions in time to evaluation and diagnosis and should be included in comprehensive pediatric cancer care programs. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

scholarly journals “A debriefer must be neutral” and other debriefing myths: a systemic inquiry-based qualitative study of taken-for-granted beliefs about clinical post-event debriefing

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Julia Carolin Seelandt ◽  
Katie Walker ◽  
Michaela Kolbe
Keyword(s):  
Interpersonal Relationships ◽  
Western Europe ◽  
Ad Hoc ◽  
Scientific Evidence ◽  
Clinical Event ◽  
Clinical Settings ◽  
Healthcare Organizations ◽  
The Usa ◽  
Open Coding ◽  
Healthcare Administrators

Abstract Background The goal of this study was to identify taken-for-granted beliefs and assumptions about use, costs, and facilitation of post-event debriefing. These myths prevent the ubiquitous uptake of post-event debriefing in clinical units, and therefore the identification of process, teamwork, and latent safety threats that lead to medical error. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly. Methods We interviewed an international sample of 37 clinicians, educators, scholars, researchers, and healthcare administrators from hospitals, universities, and healthcare organizations in Western Europe and the USA, who had a broad range of debriefing experience. We adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations. Using circular questions, we intended to uncover new and tacit knowledge about barriers and facilitators of regular clinical debriefings. All interviews were transcribed and analyzed following a comprehensive process of inductive open coding. Results In total, 1508.62 min of interviews (25 h, 9 min, and 2 s) were analyzed, and 1591 answers were categorized. Many implicit debriefing theories reflected current scientific evidence, particularly with respect to debriefing value and topics, the complexity and difficulty of facilitation, the importance of structuring the debriefing and engaging in reflective practice to advance debriefing skills. We also identified four debriefing myths which may prevent post-event debriefing from being implemented in clinical units. Conclusion The debriefing myths include (1) debriefing only when disaster strikes, (2) debriefing is a luxury, (3) senior clinicians should determine debriefing content, and (4) debriefers must be neutral and nonjudgmental. These myths offer valuable insights into why current debriefing practices are ad hoc and not embedded into daily unit practices. They may help ignite a renewed momentum into the implementation of post-event debriefing in clinical settings.

Risk perception on the labour ward: A mixed methods study

2021 ◽  
Vol 26 (2) ◽  
pp. 56-63
Author(s):  
Claire McCarthy ◽  
Sarah Meaney ◽  
Marie Rochford ◽  
Keelin O’Donoghue
Keyword(s):  
Mixed Methods ◽  
Lived Experience ◽  
Healthcare Providers ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Daily Basis ◽  
Mixed Methods Study ◽  
Structured Interviews ◽  
Staff Support ◽  
Staff Wellbeing

Healthcare providers commonly experience risky situations in the provision of maternity care, and there has been increased focus on the lived experience in recent years. We aimed to assess opinions on, understanding of and behaviours of risk on the LW by conducting a mixed methods study. Staff working in a LW setting completed a descriptive questionnaire-based study, followed by qualitative structured interviews. Statistical analysis was performed with SPSS on quantitative data and thematic analysis performed on qualitative data. Nearly two thirds of staff (64%; 73/114) completed the questionnaire, with 56.2% (n = 47) experiencing risk on a daily basis. Experiencing risk evoked feelings of apprehension (68.4%; n = 50) and worry (60.2%; n = 44) which was echoed in the qualitative work. Structured clinical assessment was utilised in risky situations, and staff described “ going on autopilot” to manage these situations. A large number of respondents reflected on their provision of care following an adverse event (87.7%; n = 64). Debriefing was mentioned as an important practice following such events by all respondents. This study describes the negative terminology prevailing in emergency obstetric care. These experiences can have a profound impact on staff. Risk reduction strategies and the provision of increased staff support and training are crucial to improve staff wellbeing in stressful scenarios.

scholarly journals 320 Obstetric clinician needs assessment for a postpartum patient navigation program for low-income patients

2021 ◽  
Vol 224 (2) ◽  
pp. S210
Author(s):  
Rachel S. Ruderman ◽  
Emma C. Dahl ◽  
Brittney R. Williams ◽  
Joe M. Feinglass ◽  
Michelle Kominiarek ◽  
...  
Keyword(s):  
Needs Assessment ◽  
Low Income ◽  
Patient Navigation ◽  
Navigation Program
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