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Rea CJ, Toomey SL, Hauptman M, Rosen M, Samuels RC, Karpowicz K, Flanagan S, Shah SN. Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic. Clin Pediatr (Phila) 2024; 63:512-521. [PMID: 37309813 PMCID: PMC10863332 DOI: 10.1177/00099228231179673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most common referral departments at Boston Children's Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.
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Affiliation(s)
- Corinna J. Rea
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marissa Hauptman
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Ronald C. Samuels
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kristin Karpowicz
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Shelby Flanagan
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Snehal N. Shah
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Pelletier B, Hoyt A. The Orthopaedic NP Workforce: Results From a Nationally Representative Survey. Orthop Nurs 2024; 43:32-40. [PMID: 38266262 DOI: 10.1097/nor.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Although a growing number of nurse practitioners (NPs) are practicing in orthopaedics, little is known about the workforce. The aim of this study was to estimate the size of the orthopaedic NP workforce, compare it with the workforce of primary care NPs, and investigate the interaction effect specialty NP practice and physician relationships have on NP role perception. We selected licensed, practicing orthopaedic and primary care NPs from the 2018 National Sample Survey of Registered Nurses and compared demographics, education, experience, functional autonomy, and job outcomes. Nationally, 2,796 NPs described their specialty as orthopaedics. Compared with primary care NPs, they spent 27% more time on care coordination, were half as likely to have their own patient panel, and were most likely to say that their NP education was fully utilized when in a collaborative relationship with physicians. Differences between orthopaedic and primary care NPs may call for reform of Consensus Model that currently places specialty practice outside its regulatory network.
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Affiliation(s)
- Brittany Pelletier
- Brittany Pelletier, AGPCNP-BC, ATC, Comprehensive Rehab Consultants, Boston, MA
- Alex Hoyt, PhD, RN, Associate Professor, School of Nursing, MGH Institute of Health Professions, Boston, MA
| | - Alex Hoyt
- Brittany Pelletier, AGPCNP-BC, ATC, Comprehensive Rehab Consultants, Boston, MA
- Alex Hoyt, PhD, RN, Associate Professor, School of Nursing, MGH Institute of Health Professions, Boston, MA
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3
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Stefos T, Moran EA, Poe SA, Hooker RS. Assessing the productivity of PAs and NPs. JAAPA 2022; 35:44-50. [PMID: 36219133 DOI: 10.1097/01.jaa.0000885152.52758.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT The improvement of healthcare efficiency and productivity is of international interest. Following an expansion phase of physician associate/assistant (PA) and NPs employment, the Department of Veterans Affairs (VA) assessed how and where they were being used. Using data from 134 VA medical centers, annual productivity was examined across 30 medical and surgical specialties spanning primary care, mental health, and surgery. PA productivity differences averaged 82 relative value units per full-time employee per year more than NPs, a difference of 4%. In general, PAs were found in higher productivity ranges than NP counterparts. PAs and NPs have statistically similar productivity levels in primary care and mental health. In specialty medicine and surgery, PAs average higher annual productivity than NPs. This analysis provides some utility for managers regarding workforce composition, given the relative productivity of two types of clinicians.
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Affiliation(s)
- Theodore Stefos
- Theodore Stefos was an economist in the US Department of Veterans Affairs (VA) and an assistant professor in Boston University's School of Public Health in Boston, Mass. In the VA's Office of Productivity, Efficiency, and Staffing in West Haven, Conn., Eileen A. Moran is director, and Stacy A. Poe is a program analyst. Roderick S. Hooker is a health policy analyst. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Patel SY, Huskamp HA, Frakt AB, Auerbach DI, Neprash HT, Barnett ML, James HO, Mehrotra A. Frequency Of Indirect Billing To Medicare For Nurse Practitioner And Physician Assistant Office Visits. HEALTH AFFAIRS (PROJECT HOPE) 2022; 41:805-813. [PMID: 35666969 DOI: 10.1377/hlthaff.2021.01968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nurse practitioners (NPs) and physician assistants (PAs) represent a growing share of the health care workforce, but much of the care they provide cannot be observed in claims data because of indirect (or "incident to") billing, a practice in which visits provided by an NP or PA are billed by a supervising physician. If NPs and PAs bill directly for a visit, Medicare and many private payers pay 85 percent of what is paid to a physician for the same service. Some policy makers have proposed eliminating indirect billing, but the possible impact of such a change is unknown. Using a novel approach that relies on prescriptions to identify indirectly billed visits, we estimated that the number of all NP or PA visits in fee-for-service Medicare data billed indirectly was 10.9 million in 2010 and 30.6 million in 2018. Indirect billing was more common in states with laws restricting NPs' scope of practice. Eliminating indirect billing would have saved Medicare roughly $194 million in 2018, with the greatest decrease in revenue seen among smaller primary care practices, which are more likely to use this form of billing.
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Affiliation(s)
- Sadiq Y Patel
- Sadiq Y. Patel, Harvard University, Boston, Massachusetts
| | | | - Austin B Frakt
- Austin B. Frakt, Veterans Affairs Boston Healthcare System, Harvard University, and Boston University, Boston, Massachusetts
| | - David I Auerbach
- David I. Auerbach, State of Massachusetts, Boston, Massachusetts
| | - Hannah T Neprash
- Hannah T. Neprash, University of Minnesota, Saint Paul, Minnesota
| | | | - Hannah O James
- Hannah O. James, Brown University, Providence, Rhode Island
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5
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Richard JV, Huskamp HA, Barnett ML, Busch AB, Mehrotra A. A methodology for identifying behavioral health advanced practice registered nurses in administrative claims. Health Serv Res 2022; 57:973-978. [PMID: 35332555 PMCID: PMC9264473 DOI: 10.1111/1475-6773.13974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE (STUDY QUESTION) Advance practice registered nurses (APRNs) play an increased role in mental illness treatment. Health services research that uses claims to study mental health is often limited because behavioral health nurse practitioners (i.e., APRNs who specialize in mental illness also known as psychiatric mental health APRNs) cannot be easily identified in claims data. We describe a methodology to identify behavioral health APRNs in administrative claims. DATA SOURCES/STUDY SETTING (W/ HOSPITAL/INSTITUTION SETTING ANONYMIZED): We use 2010-2018 claims from the traditional Medicare fee-for-service program along with 2010-2019 commercial claims and Medicare Advantage data from the OptumLabs® Data Warehouse (OLDW). Self-reported specialty data from the National Plan & Provider Enumeration System (NPPES) were used for validation. STUDY DESIGN For each APRN, we calculated the percentage of visit diagnoses and of prescriptions in each database that were for mental health and classified those with ≥80% as behavioral health APRNs. We validated our definition with NPPES self-reported specialty for Medicare data. DATA COLLECTION / EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS Among APRNs with 10+ visits, 10,978 (8.1%) in Medicare and 9829 (11.7%) in commercial claims data met our visit-based criteria as behavioral health APRNs. Among APRNs with 10+ prescriptions, 8160 (6.2%) in Medicare and 16,538 (9.0%) in commercial claims data met our prescription-based criteria as behavioral health APRNs. Among the APRNs who self-reported they were behavioral health APRNs, 92.8% and 90.5% met our visit-based and prescription-based criteria respectively. CONCLUSIONS We present and validate two methods of identifying behavioral health APRNs in claims that can be used by other researchers.
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Affiliation(s)
- Jessica V Richard
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, United States
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, United States
| | - Michael L Barnett
- Harvard School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, Massachusetts, United States.,Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, United States.,McClean Hospital, Belmont, Massachusetts, United States
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, United States.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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Kesten KS, Beebe SL. Competency frameworks for nurse practitioner residency and fellowship programs: Comparison, analysis, and recommendations. J Am Assoc Nurse Pract 2021; 34:160-168. [PMID: 33767119 DOI: 10.1097/jxx.0000000000000591] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Nurse practitioner (NP) education has followed the pattern of other health professions in recent years to place an emphasis on competency-based education. In recent years, postgraduate NP residency/fellowship programs to achieve competence and successful transition to practice have emerged and flourished. Currently, there is no standard competency framework in use for NP residency/fellowship programs in the United States, despite numerous published frameworks available. This article aimed to provide a comprehensive analysis of competency frameworks for NP education and to summarize and compare the competency frameworks used in NP education and residency/fellowship programs. Recommendations were sought for standardization of these competencies to create consistent evaluation and outcome measurements. Seven competency frameworks used across NP education and residency/fellowship programs were reviewed and compared in table format. Commonalities, differences, and themes were extracted from this comparison. There were more similarities than differences between the competency frameworks; however, common themes emerged as the emphasis on patient-centered, evidence-based practice, systems-based and quality improvement, and interprofessional practice and teamwork. The American Association of Colleges of Nursing Common Advanced Practice Registered Nurse Doctoral-Level Competencies, published in 2017, provided the most current, inclusive, comprehensive, and complete set of competencies for NPs at the time of graduation; however, they have not defined a progression indicator for postgraduate NP competency evaluation. This review of the competencies emphasizes (a) the need for consistent and consensus-based standards and (b) areas that NP education and residency/fellowship programs can strengthen to assess their ability to describe observable, measurable competencies. Instruments to evaluate competencies are recommended.
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Affiliation(s)
- Karen S Kesten
- Acute and Chronic Care Community, School of Nursing, The George Washington University, Washington, District of Columbia
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Persaud-Sharma V, Hooshmand MA. Need for Nurse Practitioner Fellowships in Ophthalmology in the USA. J Ophthalmic Vis Res 2021; 16:113-121. [PMID: 33520134 PMCID: PMC7841275 DOI: 10.18502/jovr.v16i1.8257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022] Open
Abstract
Medical attention to vision impairment and associated eye care complications are a vital component of daily living and overall well-being. In the United States today, the physician to patient deficit places great strain on the availability of medical attention tenable to patients nationwide; in terms of specialty medicine, this deficit is even more widespread. The field of ophthalmology faced the same physician to patient deficit in 2020, a grim reality that has left many states void of ophthalmic care, rending millions of aging individuals without domestic eye care. The implementation of trained, ophthalmic nurse practitioners (NPs) can fill the needs of this deficit; however, efficient, accredited, and board-approved American ophthalmic fellowships and residencies that secure proper ophthalmic NP transitions from academia to clinical practice are non-existent. Though scant, evidence-based literature presents sound findings that support the efficacy and benefit for superior patient outcomes with care provided by ophthalmic-trained NPs, offering a viable, long-term solution to the need for ophthalmic medical providers across all states without mitigating patient care, emphasizing the great need for the implementation of ophthalmic NP residencies and fellowships to ensure the continuity of impeccable ophthalmic care for all populations.
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Affiliation(s)
| | - Mary A Hooshmand
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Najmabadi S, Honda TJ, Hooker RS. Collaborative practice trends in US physician office visits: an analysis of the National Ambulatory Medical Care Survey (NAMCS), 2007-2016. BMJ Open 2020; 10:e035414. [PMID: 32565462 PMCID: PMC7311045 DOI: 10.1136/bmjopen-2019-035414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Practice arrangements in physician offices were characterised by examining the share of visits that involved physician assistants (PAs) and nurse practitioners (NPs). The hypothesis was that collaborative practice (ie, care delivered by a dyad of physician-PA and/or physician-NP) was increasing. DESIGN Temporal ecological study. SETTING Non-federal physician offices. PARTICIPANTS Patient visits to a physician, PA or NP, spanning years 2007-2016. METHODS A stratified random sample of visits to office-based physicians was pooled through the National Ambulatory Medical Care Survey public use linkage file. Among 317 674 visits to physicians, PAs or NPs, solo and collaborative practices were described and compared over two timespans of 2007-2011 and 2012-2016. Weighted patient visits were aggregated in bivariate analyses to achieve nationally representative estimates. Survey statistics assessed patient demographic characteristics, reason for visit and visit specialty by provider type. RESULTS Within years 2007-2011 and 2012-2016, there were 4.4 billion and 4.1 billion physician office visits (POVs), respectively. Comparing the two timespans, the rate of POVs with a solo PA (0.43% vs 0.21%) or NP (0.31% vs 0.17%) decreased. Rate of POVs with a collaborative physician-PA increased non-significantly. Rate of POVs with a collaborative physician-NP (0.49% vs 0.97%, p<0.01) increased. Overall, collaborative practice, in particular physician-NP, has increased in recent years (p<0.01), while visits handled by a solo PA or NP decreased (p<0.01). In models adjusted for patient age and chronic conditions, the odds of collaborative practice in years 2012-2016 compared with years 2007-2011 was 35% higher (95% CI 1.01 to 1.79). Furthermore, in 2012-2016, NPs provided more independent primary care, and PAs provided more independent care in a non-primary care medical specialty. Preventive visits declined among all providers. CONCLUSIONS In non-federal physician offices, collaborative care with a physician-PA or physician-NP appears to be a growing part of office-based healthcare delivery.
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Affiliation(s)
- Shahpar Najmabadi
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Trenton J Honda
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Facilitators, barriers, benefits, and funding to implement postgraduate nurse practitioner residency/fellowship programs. J Am Assoc Nurse Pract 2020; 33:611-617. [PMID: 32282566 DOI: 10.1097/jxx.0000000000000412] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND A current trend to address the increasing numbers of new graduate nurse practitioners (NPs) and the expanding scope of practice of NPs is the emergence of employer-based postgraduate NP residency/fellowship programs. PURPOSE The purpose of this study was to conduct a comprehensive examination of postgraduate NP residency/fellowship programs in the United States, to gain an understanding of the facilitators, barriers, benefits, and funding of these programs, from the perspective of the program directors. METHODS This exploratory study used a quantitative design to conduct an online survey, developed by the researchers, of program directors of postgraduate NP residency/fellowship programs. Descriptive statistics were generated for continuous variables: the mean, SD, and minimum, and maximum values, and for categorical variables, frequency and percentage were reported. RESULTS More than 90% of program directors indicated that NP recruitment and retention were benefits to organizations implementing NP residency/fellowship programs. Decision makers in organizations support postgraduate NP residency/fellowship programs and few barriers exist to implement programs. More than 84% indicated that physician and administrative support were facilitators to program implementation. Less than 50% of program directors identified barriers to implementation. Less than half of programs received funding sources for program implementation. IMPLICATIONS FOR PRACTICE This study provides data and insight into the emerging industry of postgraduate NP residency/training programs and informs regulators, educators, and employers about how to maximize the facilitators, reduce and decrease barriers, identify sources of funding, and appreciate the benefits of implementing programs.
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10
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Bohnhoff JC, Taormina JM, Ferrante L, Wolfson D, Ray KN. Unscheduled Referrals and Unattended Appointments After Pediatric Subspecialty Referral. Pediatrics 2019; 144:peds.2019-0545. [PMID: 31704770 DOI: 10.1542/peds.2019-0545] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Incomplete subspecialty referrals, whether unscheduled or unattended, represent unmet patient needs and an opportunity to improve patient safety and experiences. Our objectives were to describe the rates of appointment scheduling and visit attendance after pediatric subspecialty referral and to examine patient and systems factors associated with scheduled referrals and attended appointments. METHODS We conducted a retrospective review of referrals within a network of 52 primary and urgent care sites from November 2016 to October 2017. We included referrals for children ≤17 years old referred to medical or surgical subspecialists. We examined patient and health systems factors associated with (1) appointment scheduling and (2) visit attendance. RESULTS Of 20 466 referrals, 13 261 (65%) resulted in an appointment scheduled within 90 days and 10 514 (51%) resulted in a visit attended within 90 days. In adjusted analyses, referral to surgical subspecialists was associated with an increased likelihood of appointment scheduling but a decreased likelihood of visit attendance. Compared with appointments scheduled within 7 days, appointments with intervals from referral to scheduled appointment exceeding 7 days were associated with decreasing likelihood of visit attendance (adjusted odds ratio 8-14 days 0.48; 95% confidence interval 0.37-0.61). Patient factors associated with decreased likelihood of both appointment scheduling and visit attendance included African American race, public insurance, and lower zip code median income. CONCLUSIONS Patient and system factors were associated with variation in appointment scheduling and visit attendance. Decreased interval to appointment was significantly associated with visit attendance. These factors represent targets for interventions to improve referral completion.
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Affiliation(s)
- James C Bohnhoff
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Jill M Taormina
- Children's Community Pediatrics, Pittsburgh, Pennsylvania; and
| | | | - David Wolfson
- Children's Community Pediatrics, Pittsburgh, Pennsylvania; and
| | - Kristin N Ray
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Children's Community Pediatrics, Pittsburgh, Pennsylvania; and.,Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
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Bai G, Kelen GD, Frick KD, Anderson GF. Nurse practitioners and physician assistants in emergency medical services who billed independently, 2012–2016. Am J Emerg Med 2019; 37:928-932. [DOI: 10.1016/j.ajem.2019.01.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/25/2022] Open
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12
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Blitzer D, Stephens EH, Tchantchaleishvili V, Lou X, Chen P, Pattakos G, Vardas PN. Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey. Ann Thorac Surg 2018; 107:597-602. [PMID: 30312614 DOI: 10.1016/j.athoracsur.2018.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/12/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Changes in healthcare have led to increasing use of advanced practice providers (APPs), but their role in cardiothoracic surgery (CTS) education remains undefined. This study aimed to analyze the extent of APP use on the CTS team, their role within the hierarchy of clinical care, and the impact of physician extenders on CTS training from the resident perspective. METHODS CTS residents' responses to the 2017 Thoracic Surgery Residents Association/Thoracic Surgery Directors Association In-Service Training Examination survey regarding the role of APPs in specific clinical scenarios and perception of APP contribution to residents' educational environment were analyzed. Statistical analysis of categorical variables was performed in SPSS (version 22.0; IBM, Chicago, IL) using a Fisher's exact test and Pearson χ2 test with statistical significance set at p < 0.05. RESULTS Response rate was 82.1% (280/341). The median number of employed APPs was 16 to 20, and 50.4% (n = 141) reported 11 to 25 physician extenders at their institution. The median numbers of APPs in the operating room, floor, and intensive care unit were three, three, and two, respectively. Overall impression of APPs was positive in 87.5% (n = 245) of respondents, with 47.7% (n = 133) "very positive" and 40.1% "positive" (n = 112). In general, residents reported greater resident involvement in postoperative issues and operative consults and greater APP involvement in floor issues; 72.5% of residents had not missed a surgical opportunity due to APPs, whereas 9.6% missed an opportunity due to APPs despite being at an appropriate level of training. Of those that reported missed opportunities 44% were integrated thoracic surgery residents. There were no significant differences in APPs' operative role based on resident seniority. CONCLUSIONS The overall impression of APPs among CTS residents was favorable, and they are more commonly involved in assisting on the floor or the operating room. Occasionally residents reported missing a surgical opportunity due to APPs. There is further opportunity to optimize and standardize their role within programs to improve clinical outcomes and enhance the CTS educational experience for residents.
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Affiliation(s)
- David Blitzer
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Elizabeth H Stephens
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University, New York, New York
| | | | - Xiaoying Lou
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Peter Chen
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, Texas
| | - Greg Pattakos
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, Texas
| | - Panos N Vardas
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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13
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Martsolf GR, Barnes H, Richards MR, Ray KN, Brom HM, McHugh MD. Employment of Advanced Practice Clinicians in Physician Practices. JAMA Intern Med 2018; 178:988-990. [PMID: 29710094 PMCID: PMC6126674 DOI: 10.1001/jamainternmed.2018.1515] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines trends in advanced practice clinician employment across different physician practices in the United States.
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Affiliation(s)
- Grant R Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania.,RAND Corporation, Pittsburgh, Pennsylvania
| | - Hilary Barnes
- School of Nursing, University of Delaware, Newark, Delaware
| | - Michael R Richards
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristin N Ray
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather M Brom
- Center for Healthcare Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew D McHugh
- Center for Healthcare Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Ray KN, Drnach M, Mehrotra A, Suresh S, Docimo SG. Impact of Implementation of Electronically Transmitted Referrals on Pediatric Subspecialty Visit Attendance. Acad Pediatr 2018; 18:409-417. [PMID: 29277463 PMCID: PMC5936662 DOI: 10.1016/j.acap.2017.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/10/2017] [Accepted: 12/16/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE One barrier to timely access to outpatient pediatric subspecialty care is the complexity of scheduling processes. We evaluated the impact of implementing electronically transmitted referrals on subspecialty visit attendance. METHODS Through collaboration with stakeholders, an electronically transmitted referral order system was designed, piloted, and implemented in 15 general pediatrics practices, with 24 additional practices serving as controls. We used statistical process control methods and difference-in-differences analysis to examine visits attended, appointments scheduled, appointment nonattendance, and referral volume. Electronically transmitted referrals then were expanded to all 39 practices. We surveyed referring pediatricians at all practices before and after implementation. RESULTS From April 2015 through September 2016 there were 33,485 referral orders across all practices (7770 before the pilot, 11,776 during the pilot, 13,939 after full implementation). At pilot practices, there was a significant and sustained improvement in subspecialty visits attended within 4 weeks of referral (10.9% to 20.0%; P < .001). Relative to control practices, pilot practices experienced an 8.6% improvement (P = .001). After implementation at control practices, rates of visits attended also improved but to a smaller degree: 11.8% to 14.7% (P < .001). In survey responses, referring pediatricians noted improved scheduling processes but had continued concerns with appointment availability and referral tracking. CONCLUSIONS While electronically transmitted referrals improved visit attendance after pediatric subspecialty referral, the sizable percentage of children without attended visits, the muted effect at control practices, and pediatrician survey responses indicate that additional work is needed to address barriers to pediatric subspecialty care.
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