About This Grant:
This early-stage navigator program will fill a crucial gap within The Aroostook Medical Center's current system.
Currently, abnormal radiology results are reported to referring physicians or to the emergency department. If the patient doesn’t pursue the next steps, there is a gap in follow-up care and the likelihood of more complicated and serious outcomes.
The navigator will be the point of contact for patients and providers. S/he will work closely with primary care providers throughout the region, emergency department providers and staff, and current care managers, specifically transition of care coordinators, when a patient needs help obtaining a primary care provider. The role of the navigator is to take an active position in coordinating care and wrap-around services, ensuring that patients understand their options, recommended next steps, how to access the financial and logistical supports they need, and being a sensitive and compassionate listener.
The total number of patients to be served is difficult to estimate at this time. Currently, numbers of abnormal results for emergency exams as well as mammograms are tracked but these are just a fraction of potential patients. The navigator will track and follow up on all abnormal screenings. Reports of tracked incidences and follow-up metrics will be reported to providers and will be reviewed by the Performance Improvement Team.
This position will take a holistic view of the patient’s needs to ensure optimal results. S/he will assist patients who have no primary care provider and routine care. S/he will also play a role in identifying patients with needs that are not currently being met such as financial assistance, transportation to appointments/follow up exams, and housing concerns.
The navigator’s scope of practice is different from other providers’ in that this person will be specifically and actively monitoring, following and improving the likelihood and quality of follow-up for patients with abnormal findings. The navigator will greatly increase the chance that patients are not “falling through the cracks”.
This individual needs to be an experienced RN as this position will require communication with physicians and other providers to ensure proper care and follow up. Knowledge of the medical system and an understanding of reports are essential. Communication skills will be vital for ensuring compliance to follow- up activities and educating and caring for patients and their families.