The implementation of a lay care navigation service at the Stanford Cancer Institute.

119 Background: Lay care navigators address barriers to care, provide a single point of contact in complex health systems, and help efficiently resolve non-clinical patient issues. Despite navigation program proliferation, each is crafted to fit local institutional and patient needs. In Summer 2016, Stanford Cancer Institute (SCI) launched a care navigation pilot to improve patient engagement, facilitate better access to services, and improve coordination. The Stanford Care Navigator (SCN) program was based on a framework for lay navigation from the University of Alabama at Birmingham (UAB) who consulted on this project. This study describes the evolution of the SCN model and drivers of changes as SCN was iteratively designed and implemented. Methods: Qualitative study including document review of training materials, observation of cross-functional design meetings, stakeholder interviews, and a focus group with Care Navigators. Results: In spite of common goals of reducing patient distress and improving care coordination, the resulting SCN service is quite distinct from the consulting organization. Primary factors driving design changes were differences in: clinic access, patient populations and needs (e.g., SCN language translation needs vs. UAB poverty-related barriers), and a suite of pre-existing services at SCI (e.g. referral triage). Navigators call all new patients to address common barriers (traffic, parking vs. lack of transportation in Alabama). SCN refers some service items (e.g., financial support) to existing service groups, including Social Work. Conclusions: While Stanford navigation retains elements of the UAB-originating lay navigator program, in this radically different setting, service parameters differ substantially. The model was, therefore, substantially adapted rather than simply adopted. Ongoing evaluation explores navigators’ impact on patients and staff/providers.