Background: Head and neck (HAN) cancer is diagnosed in more than 50,000 Americans annually and is the third most common malignancy in the Veteran patient population. There are > 185,000 American HAN cancer survivors. The comprehensive nature of this disease causes challenges from diagnosis through survivorship. A lack of patient navigation program (PNP) for patients with HAN cancer often lead to fragmented care, delay in initiation of treatment, increased healthcare cost, poor cancer outcome, and a decrease in patient satisfaction.
Purpose: To improve care outcomes among patients with HAN cancer through the implementation of the PNP. Specifically, the program is targeted towards providing holistic patient-centered care, eliminating fragmented care and delays, and decreasing emotional distress and healthcare cost.
Method: In the First Phase, we conducted a need assessment for the PNP. In the Second Phase, we implemented the PNP in 2015 using current evidence and Deming’s (1993) Plan-Do-Study-Act (PDSA) model. During the Implementation Phase of the PNP, we developed a clinical algorithm and order set. We also strengthened our partnership with Non-VA Care Coordination
to expedite community care.
Outcomes: The PNP has served 140 Veterans with well over 500 clinical visits. Consistent with our expectation, the program has resulted in improved oncology infrastructure and timeliness of care. For instance, before the program, there was an average of 16 weeks from suspicion to initiation of treatment. After PNP implementation, the process now takes 4 to 6 weeks. The PNP has eliminated repeat computerized axial tomography, and thus, decreasing healthcare cost by $262,500 annually. Besides its economic impact, the PNP has also led to improved patient and provider satisfaction.
Clinical Implications: Overall, the PNP is a robust patientcentered care program which provides holistic care to patients from cancer suspicion to treatment initiation. Although the PNP continues to evolve, its implementation in BPVAHCS has had a significant impact in the care of HAN cancer patients. Due to the success of the current PNP, BPVAHCS is planning to include all cancer sites by 2020.
