Letter of Intent

Thank you for your interest in participating in the National Evidence-Based Oncology Navigation Metrics: Multisite Exploratory Study to Demonstrate Value and Sustainability of Navigation Programs.

Point of Contact Information

Name

Title

Address

City

State

Phone number

E-mail address

Institution or Practice Information

Institution or Practice Name

City

State

Setting

(Select all that apply)
Designated National Cancer Institute Cancer Center
Academic Medical Center
Commission on Cancer (CoC)-Accredited Community-Based Cancer Center
Freestanding Medical Oncology Physician Practice
Basic Cancer Program – no metrics or reports in place at time of LOI submission

The institution or practice is involved in one or more quality programs.

(Select all that apply)
Commission on Cancer Accreditation – CoC-Accredited Facility
National Accreditation Program for Breast Centers (NAPBC)
Oncology Care Model (OCM)
Quality Oncology Practice Initiative (QOPI)

How many navigators does your cancer program currently have on staff?

How many of your navigators are members of AONN+?

Are your cancer program’s analytic cases 750 or above?

Yes
No

How many oncology patients are navigated per year?

What electronic health record system is used by your institution or medical oncology practice?

Will you have the ability with your IT department to submit data within the following time data sets: within 2 weeks; complete data for most recent 3 years within 8 weeks?

Yes
No

Some examples of required data are:

Navigation encounters
Outpatient encounters
Inpatient volumes
Referrals to/from navigation department
Navigation budget
Tumor Registry
Cancer screenings
Staff training
Patient surveys

Comments

Are you aware and agreeable to the terms that AONN+, Oncology Solutions, LLC, and the American Cancer Society will have access to the program’s data and outcomes for analysis, publication, and presentations?

Yes
No

All meetings are 100% mandatory. Are you able to make this commitment? This includes 1-2 on-site meetings, weekly conference calls, and webinars, as needed.

Yes
No

Do you have your administrator’s support for this pilot?

Yes
No