OBJECTIVES:

The Patient Navigator Program focuses on improving patients’ health outcomes through enhanced chronic disease management by using patient navigators and the implementation of PN programs to include recruitment, training, assignment, and employment of such navigators.

Not Applicable.

REGULATIONS, GUIDELINES, AND LITERATURE:

This program is subject to the provisions of 45 CFR Part 92 for State, local and tribal governments and 45 CFR Part 74 for institutions of higher education, hospitals, other nonprofit organizations and commercial organizations, as applicable.

HRSA awards are subject to the requirements of the HHS Grants Policy Statement (HHS GPS) that are applicable based on recipient type and purpose of award. The HHS GPS is available at http://www.hrsa.gov/grants.

INFORMATION CONTACTS:

Regional or Local Office:   See Regional Agency Offices. Program Contact: Kyle Peplinski, Diversity Branch, Division of Diversity and Interdisciplinary Education, Bureau of Health Professions, 5600 Fisher Lane Rm. 9-36 Rockville, MD 20857, 301-443-7758.

Headquarters Office:   Kyle Peplinski 5600 Fishers Lane, Room 9-36, Rockville, Maryland 20857 Phone: (301) 443-7758

Web Site Address:   http://www.hrsa.gov

EXAMPLES OF FUNDED PROJECTS:

Not Applicable.

CRITERIA FOR SELECTING PROPOSALS:

The patient navigator program has 8 review criteria which are used to review and rank applications. Applicants should pay strict attention to addressing all of these criteria, as they are the basis upon which the reviewers will evaluate applications.

Criterion 1. Need (10 points) The applications will be reviewed on the extent to which the application describes the problem(s) and associated contributing factors to the problem(s) as follows: i. The application describes the health care service and chronic disease management environment in the service area and the need for Federal funds to support patient navigator services. ii. The project targets a health disparity population. The application describes the target population and documents their unmet chronic health care and health literacy needs and uses demographic data where appropriate. iii. If the applicant chooses to focus on a specific age group, a justification for this approach is provided. iv. The applicant describes the communities’ current assets and needs in regards to: 1) Coordination of health care services and provider referrals for individuals who are seeking prevention services, early detection of, or care for cancer or other chronic disease. 2) Involvement of community organizations in assisting individuals who are at risk for or who have cancer or other chronic diseases to receive better access to high-quality health care services. 3) Notification of individuals with chronic disease of clinical trials. 4) Prompt diagnostic and treatment resolution of abnormal findings of cancer or other chronic disease. 5) Provision of health insurance information to people who are at risk for or who have cancer or other chronic diseases. 6) Outreach to health disparity populations, including the uninsured, rural populations, and other medically underserved populations, in addition to assisting other individuals who are at risk for or who have cancer or other chronic diseases to seek preventative care. v. The application explains sufficiently why the community cannot meet the chronic disease management needs of the population in the service area. vi. The application addresses relevant barriers in the service area that the project hopes to overcome. The following barriers are discussed in relationship to the project: 1) geographic isolation 2) lack of quality health care providers 3) cultural and linguistic barriers, 4) limited transportation services 5) lack of health insurance and information about health options, and 6) socioeconomic status. vii. A map of the service area depicting the communities to be served and relevant service providers and community organizations is included. viii. Currently available resources and services relevant to the service area are identified.

Criterion 2. Response (20 Points) The extent to which the proposed project responds to the “Purpose” included in the program description. The extent to which the goals and activity plans described in the application are capable of addressing the problem and attaining the project objectives as follows: i. Clearly demonstrates the site’s capability of initiating patient navigation services, including technological capabilities. ii. The application identifies the project’s proposed goals which are in line with the identified community needs and program objectives outlined in the application guidance. There is clear evidence and rationale to support how health care outcomes of underserved populations who are at risk for or who have chronic diseases including cancer will be improved as a result of the project. iii. The application presents an outlined, effective, comprehensive, coherent strategy to carry out grant-funded activities in order to reach proposed goals. iv. Provides information potential project partners, including expertise and how the expertise relates to the goals of the PN program. The application explains why the project has decided not to partner with relevant providers or organizations. v. Discusses how the PN program will coordinate with existing authorized programs in order to facilitate access to high-quality health care services. vi. Identifies similar programs in the community, their role, and justifies the need for an additional program (this program) to serve this population. vii. Addresses the issue of how the PN program will resolve differences in executing the project and resolve “turf” issues should they arise. viii. Identifies how the PN program will strengthen health providers and relevant community organizations’ ability to serve the chronic disease needs of the community. ix. Describes how navigation efforts for the chronic diseases selected as a focus of navigation are coordinated with existing programs. x. Describes how the proposed project goals and objectives align with Healthy People 2010. xi. The applicant included a clear work plan matrix (See Attachment 7) that is reasonable, clearly articulated, and defines the goals, strategies, activities, measurable outcomes and process measures. The objectives are: specific; measurable; achievable; realistic with the proposed personnel, facilities, equipment, and community network; and doable in the stated time frame. An evaluation method is described for each objective that is effective and includes outcome measures. The work plan defines the person or organization responsible for carrying out each activity and includes an anticipated time frame. For applicants in the earlier planning stages, the applicant has identified as much of the described detail as possible and noted plans for approaching each requested steps. The work plan should include tasks for or identify plans for addressing each of the following five areas:

1) Recruitment of Patient Navigators: a. Methodology for identifying and recruiting potential patient navigators b. Plan to attract individuals with the appropriate skill mix, local knowledge, and desire to serve the target population c. Proposed number and justification for the number of navigators needed or explanation of how this number will be obtained. d. Evidence of an interested and eligible patient navigator applicant pool, including patient navigator candidates from underrepresented minority and disadvantaged populations with knowledge of local health disparity populations.

2) Training Plan a. Applicants must provide assurances that patient navigators recruited, assigned, trained, or employed using grant funds meet minimum core proficiencies, as defined by the applicant. These proficiencies must be tailored for the main focus or intervention of the navigator involved. b. Has defined minimum core proficiencies that are tailored for the main focus or intervention of the navigator involved. c. Provides assurance that each patient navigator recruited, assigned, trained, or employed meets the core proficiencies in “h” above. d. A description of and timeline for the proposed trainings for each project year, including justification for these trainings. e. Names and roles of any academic institutions or other partners to be involved in the training activities. f. Rationale for the proposed training methodologies and description of infrastructure and approvals for any distance learning. g. Plans to participate in or present at local, regional, State or national conferences focused on chronic diseases, patient support, health care systems, payment education or information on SCHIP and Medicaid or other related subjects part of the ongoing training efforts. h. Discussion of how the program will ensure that all training is culturally competent. i. Identification of how the program will maintain flexibility to address unanticipated training needs of patient navigators in a timely manner.

3) Employment of Patient Navigators a. Discussion of how the program will meet the requirement for hiring the navigators with direct knowledge of the community to be served. b. Discussion of choice to utilize volunteer and/or employed patient navigators. c. Methodology for determining salary and benefits for the navigators. d. Minimum qualifications for patient navigator employment (or how the project will establish such standards) to include: education requirements, prior work experience, appropriate background checks, specified levels of expertise in health care or the community, oversight or supervision requirements by licensed professionals, and the ability to effectively communicate in a culturally sensitivities manner. e. Supervision of patient navigators f. Plans for utilization of clinical specialists. g. If the project does not use lay health workers as navigators, a justification for the use of health professionals and discussion of how the decision impacts the recruitment and budget of the program.

4) Assignments of Patient Navigators a. Program’s plan for assigning patient navigators and for defining the roles and responsibilities of the patient navigators. b. Discussion of whether every patient navigator will be trained in all chronic diseases or if they might specialize in a chronic disease. c. Explanation of how decisions will be made in the geographic and demographic distribution of patient navigators.

5) Program Management In addition to describing how the applicant will recruit, assign, train, and employ patient navigators, the work plan should describe how the PN program will: a. Track and report on common data elements provided by HRSA, as well as develop site-specific measures. b. Participate in technical assistance through monthly conference calls and peer-learning workshops. c. Proof that the program meets or has a plan to meet requirements for local, regional and national accreditation/approval requirements for patient care and the educational program necessary to implement the project. d. Obtain Institutional Review Board (IRB) approval or describe the planned process for IRB review with timelines.

xii. The proposed patient navigator project’s goals contribute to meeting Healthy People 2010 objective. xiii. The application discusses potential challenges in designing and implementing the program activities and proposes logical, effective approaches to resolve such challenges.

Models that Work The applicant states whether or not the project proposal is based on another program that succeeded in another community. If it is based on another program, the applicant describes the program, how it was funded, and they believe it will succeed in a new community.

Criterion 3. Impact (15 Points) i. The extent to which significant community impact (stable access to care) is attainable given the proposed level of staff, resources available, proposed activities and length of the project period. a. The extent to which the program facilitates access to financial support and services to include prescription drug access. ii. The extent to which the project will increase communication among the local health care providers with an emphasis on reducing duplication of services and creating more efficient and cost effective care. a. The extent to which the applicant plans to collaborate and partner with health providers in the community and proposes an inclusive process for developing a sustainability plan. iii. The extent to which the project will meet the community’s need for culturally competent patient navigators. iv. If another similar program is or has been operational in the community, the extent to which the application should address the most pressing needs of the community. v. Future program sustainability after grant funding expires has been considered. a. The extent to which proposed training materials can be used as a community resource for future training of patient navigators. vi. The extent to which the project activities are or will be established to be replicable elsewhere and the presence of plans for dissemination of project information and results.

Criterion 4. Evaluative Measures (20 Points) The effectiveness of the methods and plans proposed to monitor and evaluate the project in relation to local needs. Responses must address current project plans as they relate to: i. An outline for how the applicant organization proposes to establish baseline measures and benchmarks that meet the Secretary’s requirements to evaluate program outcomes. ii. Ongoing quality assurance/improvement strategies that will allow the early detection and modification of ineffective strategies. iii. An understanding of how the applicant will integrate HRSA provided data measures and tools into existing evaluation systems. iv. Proposed outcome measures (crosscutting and clinical as described above) that are site-specific, given local populations and chronic disease(s) chosen, and how analysis of those measures will contribute to evaluating the project effectiveness. v. Methods to monitor and evaluate the project results and identifies the project evaluator if applicable.

Criterion 5. Resources/Capabilities (15 Points) i. The extent to which the applicant organization is capable of successfully meeting program requirements and implementing the proposed project. The organization has quality resources available to fulfill the needs of the project. ii. The extent to which current or proposed project personnel are qualified to implement and carry out the proposed project. iii. The extent to which current or proposed linkages with partners, such as community agencies, including small grassroots faith-based and community-based organizations, and other relevant Federal and local partners, enhance the capabilities for implementation of the project. iv. The extent to which the program shows demonstrated support (financial, in-kind, and other) from community leaders, agencies, institutions and other relevant local organizations for the project and its activities. v. The extent to which the applicant has a financial management system in place and the capability to manage the grant. vi. If distance learning methodologies are planned, the organization has infrastructure to support this and users will have access to technology support. vii. The extent to which the program has plans in place to ensure acceptable oversight or supervision of patient navigators.

Criterion 6. Support Requested (5 Points) The fiscal plan describes a budget that demonstrates: i. The applicant’s itemized budget table or spreadsheet is clearly presented. ii. A budget narrative (bulleted points are fine) is clearly articulated in detail for each item presented in the budget tables. iii. The budget narrative logically documents how and why each line item request (such as personnel, travel, etc.) supports the goals and activities of the proposed grant-funded activities. iv. The estimated cost to the government of proposed grant-funded activities appears reasonable. v. The budget does not include request for funding for direct health care services delivery; to purchase, construct or renovate facilities or real property; or to purchase vehicles.

Criterion 7. Health Literacy, Diversity and Cultural Competence (5 Points) The application needs a plan to ensure project diversity and cultural competence to include: i. Clear documentation that the organization’s strategic plan, policies, and initiatives demonstrate a commitment to serving the specific target population and familiarity with the culture and literacy level of the particular target group; ii. Assurance that there will be navigators from underrepresented minorities and/or from other disadvantaged backgrounds consistent with local population demographics; and iii. Convincing and clear documentation assuring that navigators will be prepared to provide culturally competent information and support.

Criterion 8. Proven History of Successful Patient Navigation Program (10 Points) If applicable, the applicant has demonstrated that they have implemented a successful patient navigation program for at least six (6) months including: i. Having recruited, assigned, trained, and employed patient navigators within their organization for at least six (6) months. ii. Have demonstrated through qualitative and quantitative means that their PN program has been successful at reducing health disparities and improving health care outcomes.

In making awards of grants under this section, preference will be given to any qualified applicant that (A) has a high rate for placing graduates in practice settings having the principal focus of serving residents of medically underserved communities; or (B) during the 2-year period preceding the fiscal year for which such an award is sought, has achieved a significant increase in the rate of placing graduates in such settings; or (C) fulfills the requirements for “new programs”. Applicants should review the HRSA Guidance documents issued under this CFDA program for preference requirements. In making awards of grants under this section, preference will be given to any qualified applicant that (A) has a high rate for placing graduates in practice settings having the principal focus of serving residents of medically underserved communities; or (B) during the 2-year period preceding the fiscal year for which such an award is sought, has achieved a significant increase in the rate of placing graduates in such settings. Applicants should review the HRSA Guidance documents issued under this CFDA program for preference requirements.