Patient navigation and care coordination at the clinic level is necessary to provide timely and high quality breast health services through the continuum of care from assessment and screening through diagnosis and treatment. A Patient Navigator is a trained individual who proactively guides patients through and around barriers in a complex cancer care system to decrease fragmentation of care and to coordinate services. Effective patient navigation ultimately enhances the patient’s experience of care.
Steps for Implementation
- Designate a staff person to coordinate breast health care services for the patient and to serve as the main point of contact for the mammography facility.
- Designated staff personnel:
- Process the mammography screening or diagnostic referral and document it in the medical record system.
- Clearly reinforce the need for mammography and answer the patient’s questions about the procedure.
- Schedule the screening or diagnostic appointment for the patient.
- Remind the patient of her appointment 1–2 days prior.
- Maintain contact with the mammography facility to receive the mammography report after the exam is complete.
- Document the results in the medical record system and follow-up with the patient as directed by the medical provider.
- Understand resources and requirements to obtain financial support for the patient when needed.
- The person providing patient navigation services should maintain continuous communication with a contact staff person at the mammography facility (or facilities) as well as with the patient.
Referral Specialist: Community Health Care Network, Fairfax County, Virginia
CHCN’s Referral Specialist (RS) is responsible for processing all radiology referrals at the clinic. The process includes the following steps:
- The RS receives referral orders from the provider and meets with the patient directly after the provider encounter to schedule the patient’s mammography appointment. The patient leaves the clinic with an appointment.
- The RS faxes the referral and required documents directly to the mammography facility.
- Two days prior to the scheduled screening exam, the RS calls the patient to remind her of the appointment. If the patient cannot make the appointment the RS can reschedule the patient for a new time and also contacts the mammography facility to cancel the appointment.
- The RS accesses the mammography facility’s results portal to review the mammography report within 72 hours of the exam and enters the results into the EMR.
- If the patient has an abnormal mammogram or requires a follow-up appointment, the RS schedules the necessary follow-up.
The RS remains the point of contact for the mammography facility until services are no longer required. In order to keep track of each patient who receives a referral, the RS documents all exams, results, and follow-up information in a protected Excel spreadsheet. Staff also use the spreadsheet for data reporting purposes and in the future plan to build it into the EMR.
Incorporating Patient Navigation Tasks into Current Roles: Greater Baden Medical Services,
Prince George’s County, Maryland
In order to ensure a sustainable change, the leadership team of Greater Baden Medical Services, Inc. decided to incorporate patient navigation responsibilities into the current roles of the staff members as opposed to creating a new position. The clinic project team of Greater Baden at Capitol Heights integrated the breast health care patient navigation roles into current staff duties at the clinic. Providers process the mammography referral and document it in the EMR. The front desk staff scans in mammography results received at the clinic into the EMR and records the BI-RAD result in a drop-down menu. If results are not received by the clinic within a certain amount of time, Medical Assistants follow up with the patient to determine whether or not she completed the mammogram.
Montgomery County Safety-Net Clinics Breast Health Patient Navigation: Montgomery County, Maryland
While some Montgomery County safety-net clinics have created patient navigator positions, others, similar to Greater Baden, incorporate the responsibilities into current staff positions. The amount of time it takes per week depends on the total number of patients seen at the clinic as well as follow-up required for patients with abnormal results. For some clinics, it may take as little as 4 hours per week and in others, up to 8 hours. In each of the clinics, staff members with multiple responsibilities should set aside a designated time each week to focus only on breast health referral and follow-up. Without that “protected time”, navigation responsibilities are easily overwhelmed by direct patient care needs.
Frequently Asked Questions
Q1. Our clinic can’t support a new full time Breast Health Patient Navigator, how can we still provide services?
A1. Patient navigation for breast healthcare does not require a full-time position. The responsibility can be incorporated into positions that your clinic has already. For example, some clinics have a Referral Specialist who processes all referrals and follow-up with other facilities. Other clinics have their Certified Medical Assistant (CMA) conduct follow-up calls to ensure that patients keep their appointment or have the opportunity to reschedule an appointment. In these same clinics, the front desk staff is responsible for documenting the mammography results.
Q2. If the hospital or radiology provider has a nurse navigator, do we still need one?
A2. Yes, it is important that there is a designated person at the clinic level to be the point of contact between the primary care provider, the patient, and the diagnostic services and treatment provider. The nurse navigator at the hospital may help with coordinating services at the hospital level, but he/she will also need someone at the clinic to help keep the providers and the patient in the loop as the patient receives care. It is important to clearly define roles and responsibilities of the hospital, radiology, and clinic staff in order to avoid duplication of effort while ensuring high quality integrated care.