Role of advanced practice providers (APP) in meeting rising demands on oncology practices.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18372-e18372
Author(s):  
Bela Bapat ◽  
Yolaine Smith ◽  
Andrew Klink ◽  
Chadi Nabhan ◽  
Bruce A. Feinberg
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Patient Treatment ◽  
Advanced Practice ◽  
Physician Burnout ◽  
Community Oncology ◽  
Practice Efficiency ◽  
Physician Availability

e18372 Background: The role of advanced practice providers (APPs), nurse practitioners (NPs) and physician assistants (PAs), is expanding in oncology for myriad reasons including improving access to care by closing the gap between demand for services and physician availability. This is especially true in oncology, where the shortage of oncologists and increasingly cited physician burnout is creating challenges for many practices and communities. Methods: We surveyed US physicians to understand their practices’ use of APPs, their role in patient treatment and support as well as their impact on practice workflow. Data were collected using web-based instrument between Sep 2018 and Nov 2018. Responses have been summarized using descriptive statistics. Results: Among 163 oncologists and hematologists surveyed, 74.2% (n = 121) employed NPs, 39.9% (n = 65) employed PAs, and 19.0% (n = 31) did not employ any APPs in their practice. Amongst practices that employed ≥1 APP (n = 132; 81.0%), over 40% of physicians reported a 1:3 APP: physician ratio. Most (62.1%) physicians stated that APPs only evaluated and saw returning patients, whereas 35.6% physicians used APPs to evaluate and see both new and return patients. More than 60% of physicians stated that APPs enhanced their practice efficiency, enabled physicians to focus more on complex patient cases, and made their workload manageable. By employing APPs, 52.3% of physicians were able to increase their patient caseload. The majority (57.6%) of physicians reported that they would employ more APPs in the next 3 years if resources were available, and 41.7% of physicians reported that APPs would likely take on additional responsibility in the next 3 years. Conclusions: Most community oncology practices in the US are employing APPs and are finding significant value in the APP roles by delegating various aspects of patient care to them. Most community practices are considering increasing the number of employed APPs and to expand the breadth of their responsibility. Integrating APPs into oncology practices is likely to have a larger impact on quality of patient care and potential mitigation of physician burnout.

Practice Model for Advanced Practice Providers in Oncology

2017 ◽  
pp. 40-43
Author(s):  
Jamie Cairo ◽  
Mary Ann Muzi ◽  
Deanna Ficke ◽  
Shaunta Ford-Pierce ◽  
Katrina Goetzke ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Professional Growth ◽  
Physician Assistants ◽  
Advanced Practice ◽  
Quality Improvements ◽  
Collaborative Relationships ◽  
Practice Model ◽  
Patients With Cancer

According to ASCO, the number of practicing oncologists has remained stable despite growth demands, leading to an overall shortage in many areas of the country. Nurse practitioners and physician assistants are advanced practice providers (APPs) who can assist in the provision of support and care to patients with cancer, but the role of the APP in the oncology setting has not been well defined. There exists a variety of different practice patterns for APPs who work in oncology, and the lack of role definition and absence of an established practice model are considered leading causes of APP attrition. According to the American Academy of Nurse Practitioners, it has been well demonstrated that, when nurse practitioners are allowed to work to the full scope of their education and preparation, there are notable cost reductions and quality improvements in patient care. The focus of APP education and training is on health promotion, disease prevention, and primary care medical management, but most APPs have limited exposure to management of cancer in patients. With this in mind, Aurora Cancer Care developed a practice model for APPs who work in oncology. The goal of the model is to enhance the quality of care delivered to patients and provide a stimulating work environment that fosters excellent collaborative relationships with oncologist colleagues, supports professional growth, and allows APPs to practice to the full extent of their licensure.

Scope of practice of advanced practice providers (APP) in US community oncology.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6646-6646
Author(s):  
Andrew Klink ◽  
Bela Bapat ◽  
Yolaine Smith ◽  
Chadi Nabhan ◽  
Bruce A. Feinberg
Keyword(s):  
Patient Education ◽  
Supportive Care ◽  
Nurse Practitioners ◽  
Systemic Therapy ◽  
Physician Assistants ◽  
Scope Of Practice ◽  
Advanced Practice ◽  
Bone Marrow Biopsies ◽  
Community Oncology ◽  
Eol Care

6646 Background: Oncology practices are increasingly employing nurse practitioners (NPs) and physician assistants (PAs) known collectively as advanced practice providers (APPs) to improve practice workflow, increase efficiency, and enable physicians to focus on complex patient care. Understanding variations in scope of practice for APPs may help establish a benchmark against which future changes are measured. Methods: US community physicians responded to a web-based survey from Sep to Nov 2018. Physicians were asked how frequently their APPs performed certain tasks on a 5-point scale (i.e., never, occasionally, sometimes, frequently, and always). Responses have been summarized using descriptive statistics. Results: In this study, 163 physicians were surveyed, most (81.0%, n = 132) used APPs in their practice. Among physicians using APPs, 91.7% (n = 121) used NPs and 49.2% (n = 65) used PAs. Most physicians stated that APPs were frequently/always involved in providing patient education (84.1%), ordering imaging and laboratory studies (68.9%), and/or making supportive care decisions (62.1%). Over 85% (57.6%-59.8% occasionally/sometimes; 28.0%-28.8% frequently/always) of physicians agreed that APPs discussed imaging reports and end of life (EOL) care (57.6% occasionally/sometimes, 28.8% frequently/always) with patients. Regarding procedures: 51.9% (28.0% occasionally/sometimes; 24.1% frequently/always) responded that APPs performed bone marrow biopsies and intrathecal chemotherapy. Regarding systemic therapy: 68.2% (58.3% occasionally/ sometimes; 9.8% frequently) allowed APPs to modify existing regimen e.g., dose/schedule change; 39.4% responded that APPs made decisions about new therapy selection. Conclusions: While substantial variation in the role of APPs in community oncology practices was observed, similar themes emerged. APPs appear to be integral in patient education, ordering laboratory and imaging studies, and discussing EOL care. Fewer are involved in managing and selecting supportive care and systemic therapy. Longitudinal and longer follow up are warranted to ascertain whether the scope of these practices change over time.

scholarly journals Understanding the Role of Advanced Practice Providers in Oncology in the United States

2018 ◽  
Vol 14 (9) ◽  
pp. e518-e532 ◽  
Author(s):  
Suanna S. Bruinooge ◽  
Todd A. Pickard ◽  
Wendy Vogel ◽  
Amy Hanley ◽  
Caroline Schenkel ◽  
...  
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Clinical Care ◽  
Gynecologic Oncology ◽  
Physician Assistants ◽  
The United States ◽  
Direct Patient Care ◽  
Advanced Practice ◽  
Patient Counseling ◽  
Number Of Patients

Purpose: Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all oncology APPs and, second, to understand personal and practice characteristics (including compensation) of those APPs. Methods: We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. Results: We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is approximately $10,000 higher than average pay for nononcology APPs. Conclusion: We identified 5,350 oncology APPs and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.

scholarly journals Role of Oncology Clinical Pharmacists in Light of the Oncology Workforce Study

2010 ◽  
Vol 6 (5) ◽  
pp. 270-272 ◽  
Author(s):  
Jolynn K. Sessions ◽  
John Valgus ◽  
Sally Yowell Barbour ◽  
Lew Iacovelli
Keyword(s):  
Patient Education ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Direct Patient Care ◽  
Clinical Pharmacists

To date, the information published regarding workforce implications has focused on physicians, nurse practitioners, and physician assistants. But oncology clinical pharmacists also can assist with direct patient care and patient education activities.

The Evolving Role of Advanced Practice Providers in Otolaryngology: Improving Patient Access and Patient Satisfaction

2021 ◽  
pp. 019459982110203
Author(s):  
Pratyusha Yalamanchi ◽  
Meredith Blythe ◽  
Kristi S. Gidley ◽  
William R. Blythe ◽  
Richard W. Waguespack ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Care Delivery ◽  
Physician Assistants ◽  
Neck Surgery ◽  
Physician Workforce ◽  
Advanced Practice ◽  
Patient Access ◽  
Few Data ◽  
Improve Access

The aging US population requires an increasing volume of otolaryngology–head and neck surgery services, yet the otolaryngologist physician workforce remains static. Advanced practice providers (APPs), including physician assistants and nurse practitioners, improve access across the continuum of primary and subspecialty health care. The rapid growth of APP service is evidenced by a 51% increase in APP Medicare billing for otolaryngology procedures over 5 years. APPs increasingly participate in delivering otolaryngology care; however, reaping the benefits of enhanced patient access and modernizing care delivery is predicated on successful integration of APPs into practices. Few data are available on how best to incorporate APPs into team-based models or how to restructure practices to allow graduated responsibility that supports autonomy and effective teamwork. We compare national APP and physician workforce trends in otolaryngology, consider approaches to optimizing efficiency by integrating APPs, and identify opportunities for improving data collection and practice.

Organization and Structure of the Cardiothoracic Intensive Care Unit

2015 ◽  
pp. 86-104
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Organization and Structure of the Cardiothoracic Intensive Care Unit

Oncology ◽  
2017 ◽  
pp. 709-727
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Outcomes of Tube Thoracostomies Performed by Advanced Practice Providers vs Trauma Surgeons

2008 ◽  
Vol 17 (4) ◽  
pp. 357-363 ◽  
Author(s):  
Laura C. Bevis ◽  
Gina M. Berg-Copas ◽  
Bruce W. Thomas ◽  
Donald G. Vasquez ◽  
Ruth Wetta-Hall ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Insertion Site ◽  
Physician Assistants ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Advanced Practice ◽  
Trauma Centers ◽  
Significant Difference ◽  
Trauma Surgeons

Background The role of advanced registered nurse practitioners and physician assistants in emergency departments, trauma centers, and critical care is becoming more widely accepted. These personnel, collectively known as advanced practice providers, expand physicians’ capabilities and are being increasingly recruited to provide care and perform invasive procedures that were previously performed exclusively by physicians. Objectives To determine whether the quality of tube thoracostomies performed by advanced practice providers is comparable to that performed by trauma surgeons and to ascertain whether the complication rates attributable to tube thoracostomies differ on the basis of who performed the procedure. Methods Retrospective blinded reviews of patients’ charts and radiographs were conducted to determine differences in quality indicators, complications, and outcomes of tube thoracostomies by practitioner type: trauma surgeons vs advanced practice providers. Results Differences between practitioner type in insertion complications, complications requiring additional interventions, hospital length of stay, and morbidity were not significant. The only significant difference was a complication related to placement of the tube: when the tube extended caudad, toward the feet, from the insertion site. Interrater reliability ranged from good to very good. Conclusions Use of advanced practice providers provides consistent and quality tube thoracostomies. Employment of these practitioners may be a safe and reasonable solution for staffing trauma centers.

scholarly journals An activity analysis of Dutch hospital-based physician assistants and nurse practitioners

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
G. T. W. J. van den Brink ◽  
A. J. Kouwen ◽  
R. S. Hooker ◽  
H. Vermeulen ◽  
M. G. H. Laurant
Keyword(s):  
The Netherlands ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Hospital Management ◽  
Physician Assistants ◽  
Added Value ◽  
Direct Patient Care ◽  
Patient Scheduling ◽  
Dutch Hospital ◽  
Medical Specialties

Abstract Background The physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management. Study design A descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated. Methods The patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system. Findings In total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care. Conclusions NPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands.

Sign in / Sign up

Export Citation Format

Share Document