Table 3.

Original and Modified Descriptions of Principles for Patient Navigation by Category

Code	Freeman Definition	Modified Description for Coding	Concordant	Discordant	Not Observed
Individual-level principles
Eliminating barriers to timely care	“The core function of patient navigation is the elimination of barriers to timely care across all segments of the healthcare continuum.”	Any action taken by the navigator that reduces a barrier to following through on care	10	0	0
Providing patient-centric care	“Patient navigation is a patient-centric healthcare service delivery model.”	An action performed that focuses on providing a service that intends to move an individual through care (attend appointments, get treatment, etc.)	10	0	0
Integrate fragmented system	“Patient navigation serves to virtually integrate a fragmented healthcare system for the individual patient.”	Navigator actions on behalf of a specific patient that serve to keep the patient flowing through the process of diagnosis/treatment. Integration can be classified in two ways: (1) Navigators coordinate with members of the clinical team to move patients through care; and (2) Navigators contact multiple departments, specialties, hospitals and clinics to facilitate care coordination for patients between these separate entities	9	1	0
Navigate across disconnected system	“There is a need to navigate patients across disconnected systems of care, such as primary care sites and tertiary care sites.”
Program-level principles
Program cost effectiveness	“Delivery of patient navigation services should be cost effective and commensurate with the training and skills necessary to navigate an individual through a particular phase of the care continuum.”	Actions taken by navigators that demonstrate strategies utilized by programs to maintain services in a clinically efficient manner	4	1	5
Level of skill is defined	“The determination of who should navigate should be determined by the level of skills required at a given phase of navigation.”	Programs hire navigators into positions with a specific skill set defined. This level of skill should be matched to the needs of patient in the phase on the cancer continuum where navigation activities are performed	2	8	0
Defined beginning and end of navigation	“In a given system of care there is a need to define the point at which navigation begins and the point at which navigation ends.”	There are specific points of entry where navigators get involved in patient care, and a point at which the navigator no longer handles the case	8	0	2
Clear scope of role	“Patient navigation should be defined with a clear scope of practice that distinguishes the role and responsibilities of the navigator from that of all other providers.”	Tasks that demonstrate the defined role of the navigator within the team	5	5	0
System is coordinated	“Patient navigation systems require coordination.”	There is a person/group who coordinates and/or oversees navigation activities at the site	6	0	4
		There are defined and established metrics or goals that the navigator must meet and/or report. Reporting may be to an outside agency or internal to the organization	4	0	6
System improvement	Not included	Any action taken by a navigator that aims to improve inefficient systems that create barriers for navigator in carrying out their role	7	1	2
Resource identification	Not included	Actions that reflect the unorthodox ways in which navigators find and utilize funding and resources to provide navigation services	10	0	0