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Yoke LH, Boeckh M, Beieler AM. Integrating Infectious Disease Advanced Practice Providers in the Workforce: An Educational Step Forward. Open Forum Infect Dis 2024; 11:ofae232. [PMID: 38770213 PMCID: PMC11103615 DOI: 10.1093/ofid/ofae232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Leah H Yoke
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Michael Boeckh
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Alison M Beieler
- Infectious Diseases Clinic, Harborview Medical Center, Seattle, Washington, USA
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Rawson JV, Rubin E, Smetherman D. Short-Term Strategies for Augmenting the National Radiologist Workforce. AJR Am J Roentgenol 2024. [PMID: 38568035 DOI: 10.2214/ajr.24.30920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
The current radiology landscape has an imbalance between the rising demand for radiology services and the national radiologist workforce available. More vacant radiology positions exist than graduating radiology trainees. The origins of this problem are complex and require long-term solutions. Rather than working longer and/or faster, there are ways for radiologist to work smarter. In this article, we present multiple short-term strategies to increase the effective radiologist workforce and/or increase workforce efficiency, in order to alleviate the current workload challenges. These strategies are derived based on an analysis of possible practice-level changes in personnel, process, and physical plant. The impacts of the potential changes are estimated. No single change addresses the mismatch between supply and demand for radiology services. By creating an inventory of potential solutions, practices can choose the potential mechanism(s) to address the workforce shortage that best fit their needs and local environment.
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Affiliation(s)
- James V Rawson
- Vice Chair of Operations & Special Projects, Department of Radiology, Beth Israel Medical Center, Harvard Medical School, One Deconess Road, Boston, MA 02215
| | - Eric Rubin
- Medical Director, CT Division, Crozer Health, 1 Medical Center Blvd, Upland, PA 19013
| | - Dana Smetherman
- Chair, Department of Radiology, Ochsner Medical Center - New Orleans, 1516 Jefferson Hwy., New Orleans, LA 70121
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Tagle-Cornell MC, Novais BS, Wen S, Shipman JN, Mandale DR, Flom AP, Sahnan SK, Kriz LM, Alland ML, Bird CW, Naqvi TZ. Hand-Held Echocardiography by Advanced Practice Providers in Patients with Congestive Heart Failure. J Clin Med 2024; 13:312. [PMID: 38256445 PMCID: PMC10816508 DOI: 10.3390/jcm13020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES The performed hand-held echocardiography (HHE) was evaluated and interpreted by trained advanced practice providers (APPs) on hospitalized CHF patients for image quality and interpretation by comparing with expert echocardiographer and SE findings. BACKGROUND Congestive heart failure (CHF) is associated with increased hospital admissions and mortality. While a standard echocardiogram (SE) is the gold standard for cardiac assessment, it is not readily available. Hospitalized CHF patients require rapid assessment for expedited treatment. METHODS Over 6 months, five trained APPs performed HHE on hospitalized CHF patients and interpreted: (a) left ventricular (LV) size, (b) LV ejection fraction (LVEF), and (c) right atrial pressure (RAP). The study echocardiographer reviewed and blindly interpreted the HHE images and compared them with APPs and SE findings. Kappa statistics determined the degree of agreement between APPs and the study echocardiographer's interpretation of the HHE images and SE. RESULTS A total of 80 CHF patients (age 73 ± 14 years, 58% males; LVEF (by SE) 45 ± 19%; 36.3% body mass indexes ≥ 30 kg/m2) were enrolled. HHE interpretation by APPs had a good agreement for LVEF (kappa 0.79) with the study echocardiographer and SE (kappa 0.74) and a good agreement for RAP (kappa 0.67) with the study echocardiographer. The correlation between the absolute LVEF interpretation by the study echocardiographer on HHE and SE was r = 0.88 (p < 0.0001). CONCLUSIONS Trained APPs obtained diagnostic-quality HHE images and interpreted the LV function and RAP in CHF patients in good agreement with the study echocardiographer. LVEF by HHE correlated with LVEF by SE. Our study suggests trained APPs can use HHE to evaluate LVEF and RAP in CHF patients, leading to expedited and optimized treatment.
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Affiliation(s)
- Maria Cecilia Tagle-Cornell
- Division of Echocardiography, Department of Cardiovascular Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; (B.S.N.); (S.W.); (J.N.S.); (D.R.M.); (A.P.F.); (S.K.S.); (L.M.K.); (M.L.A.); (C.W.B.)
| | | | | | | | | | | | | | | | | | | | - Tasneem Z. Naqvi
- Division of Echocardiography, Department of Cardiovascular Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; (B.S.N.); (S.W.); (J.N.S.); (D.R.M.); (A.P.F.); (S.K.S.); (L.M.K.); (M.L.A.); (C.W.B.)
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Antkowiak PS, Lai SY, Burke RC, Janes M, Zawi T, Shapiro NI, Rosen CL. Characterizing malpractice cases involving emergency department advanced practice providers, physicians in training, and attending physicians. Acad Emerg Med 2023; 30:1237-1245. [PMID: 37682564 DOI: 10.1111/acem.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE The objective was to evaluate available characteristics and financial costs of malpractice cases among advanced practice providers (APPs; nurse practitioners [NPs] and physician assistants [PAs]), trainees (medical students, residents, fellows), and attending physicians. METHODS This study was a retrospective analysis of claims occurring in the emergency department (ED) from January 1, 2010, to December 31, 2019, contained in the Candello database. Cases were classified according to the provider type(s) involved: NP, PA, trainee, or cases that did not identify an extender as being substantially involved in the adverse event that resulted in the case ("no extender"). RESULTS There were 5854 cases identified with a total gross indemnity paid of $1,007,879,346. Of these cases, 193 (3.3%) involved an NP, 513 (8.8%) involved a PA, 535 (9.1%) involved a trainee, and 4568 (78.0%) were no extender. Cases where a trainee was involved account for the highest average gross indemnity paid whereas no-extender cases are the lowest. NP and PA cases differed by contributing factors compared to no-extender cases: clinical judgment (NP 89.1% vs. no extender 76.8%, p < 0.0001; PA 84.6% vs. no extender, p < 0.0001), documentation (NP 23.3% vs. no extender 17.8%, p = 0.0489; PA 25.9% vs. no extender, p < 0.0001), and supervision (NP 22.3% vs. no extender 1.8%, p < 0.0001; PA 25.7% vs. no extender p < 0.0001). Cases involving NPs and PAs had a lower percentage of high-severity cases such as loss of limb or death (NP 45.6% vs. no extender 50.2%, p = 0.0004; PA 48.3% vs. no extender, p < 0.0001). CONCLUSIONS APPs and trainees comprise approximately 21% of malpractice cases and 33% of total gross indemnity paid in this large national ED data set. Understanding differences in characteristics of malpractice claims that occur in emergency care settings can be used to help to mitigate provider risk.
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Affiliation(s)
- Peter S Antkowiak
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Shin-Yi Lai
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan C Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Janes
- CRICO/Risk Management Foundation, Boston, Massachusetts, USA
| | - Tarek Zawi
- CRICO/Risk Management Foundation, Boston, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Carlo L Rosen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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Jiang C, Jain NP, Grant-Kels JM. Ethical implications of limiting Medicaid patients to advanced practice providers. J Am Acad Dermatol 2023:S0190-9622(23)03015-3. [PMID: 37844690 DOI: 10.1016/j.jaad.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Christina Jiang
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Neelesh Patrick Jain
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida.
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Dugani SB, Fischer KM, Schroeder DR, Geyer HL, Maniaci MJ, Paulson M, Croghan IT, Burton MC. Global well-being, anxiety, social isolation, and emotional support among hospitalists during COVID-19 and Mpox outbreaks. Hosp Pract (1995) 2023; 51:211-218. [PMID: 37491767 PMCID: PMC10775116 DOI: 10.1080/21548331.2023.2241342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE The Coronavirus Disease-19 (COVID-19) pandemic caused a decline in hospitalist wellness. The COVID-19 pandemic has evolved, and new outbreaks (i.e. Mpox) have challenged healthcare systems. The objective of the study was to assess changes in hospitalist wellness and guide interventions. METHODS We surveyed hospitalists (physicians and advanced practice providers [APPs]), in May 2021 and September 2022, at a healthcare system's 16 hospitals in four US states using PROMIS® measures for global well-being, anxiety, social isolation, and emotional support. We compared wellness score between survey periods; in the September 2022 survey, we compared wellness scores between APPs and physicians and evaluated the associations of demographic and hospital characteristics with wellness using logistic (global well-being) and linear (anxiety, social isolation, emotional support) regression models. RESULTS In May 2021 vs. September 2022, respondents showed no statistical difference in top global well-being for mental health (68.4% vs. 57.4%) and social activities and relationships (43.8% vs. 44.3%), anxiety (mean difference: +0.8), social isolation (mean difference: +0.5), and emotional support (mean difference: -1.0) (all, p ≥ 0.05). In September 2022, in logistic regression models, APPs, compared with physicians, had lower odds for top (excellent or very good) global well-being mental health (odds ratio [95% CI], 0.31 [0.13-0.76]; p < 0.05). In linear regression models, age <40 vs. ≥40 years was associated with higher anxiety (estimate ± standard error, 2.43 ± 1.05; p < 0.05), and concern about contracting COVID-19 at work was associated with higher anxiety (3.74 ± 1.10; p < 0.01) and social isolation (3.82 ± 1.21; p < 0.01). None of the characteristics showed association with change in emotional support. In September 2022, there was low concern for contracting Mpox in the community (4.6%) or at work (10.0%). CONCLUSION In hospitalists, concern about contracting COVID-19 at work was associated with higher anxiety and social isolation. The unchanged wellness scores between survey periods identified opportunities for intervention. Mpox had apparently minor impact on wellness.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Holly L. Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Ivana T. Croghan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Research Hub, Mayo Clinic, Rochester, MN, USA
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Sim ES, Belsky MA, Konanur A, Yan A, Shaffer AD, Williams K, Martsolf GR, Chi DH, Jabbour N. Adherence to Tympanostomy Tube Clinical Practice Guidelines in an Advanced Practice Provider Clinic. Ann Otol Rhinol Laryngol 2023; 132:1110-1116. [PMID: 36412134 DOI: 10.1177/00034894221135282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE We compared adherence rates by attending otolaryngologists (OTOs) and advanced practice providers (APPs) to the 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG) for children with recurrent acute otitis media (RAOM) undergoing bilateral myringotomy and tympanostomy tube placement (BMT). METHODS Patients aged 6 months to 12 years old undergoing BMT for RAOM who had a pre-operative visit with an independent APP or OTO were reviewed. Patients satisfied CPG criteria if middle ear effusion was identified at the pre-operative visit (pre-op) or if they did not have effusion but met exception criteria based on their risk for developmental difficulties and contraindications to medical therapy. Adherence rates between APPs and OTOs were compared. Agreement between pre-op and time-of-surgery middle ear effusion identification was assessed. RESULTS Nine hundred twenty-three patients were included. Six hundred one patients were seen by OTOs and 322 by APPs. Middle ear effusion was identified at pre-op in 84% of APP patients and in 76% of OTO patients (P = .005). Eight percent of APP patients and 11% of OTO patients met exception criteria (P = .138). Overall, 87% of OTO patients and 92% of APP patients met either CPG or exception criteria for BMT (P = .037). A logistic regression model demonstrated that pre-op provider type did not significantly impact rates of agreement between pre-op visit and time-of-surgery middle ear effusion identification. CONCLUSIONS Independent APP-led clinics can reliably and effectively deliver evidence-based care for prevalent conditions such as RAOM at similar rates of adherence to CPGs as OTOs.
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Affiliation(s)
- Edward S Sim
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael A Belsky
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anisha Konanur
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annie Yan
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | | | - David H Chi
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Noel Jabbour
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Cooper C, Mastroianni R, Bosque E, Chabra S, Campbell J, Perez JA, White CF, James J, Umoren RA. Quality indices and outcomes of a neonatology telerounding program in a Level II NICU: Single center experience during the COVID-19 pandemic. Am J Perinatol 2023. [PMID: 37348545 DOI: 10.1055/a-2115-8530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The objective of this program evaluation was to describe the outcomes of daily neonatologist telerounding with the onsite Advanced Practice Provider (APP) in a Level II NICU, before and during the COVID-19 pandemic. STUDY DESIGN Bedside telerounding occurred with an onsite APP using a telehealth cart and paired Bluetooth stethoscope. Data collected by longitudinal and cross-sectional surveys and chart review before (May 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic were analyzed using descriptive statistics and thematic analysis. RESULTS A total of 258 patients were admitted to the Level II NICU before (May 2019-Feb 2020) and during (March 2020-Feb 2021) the COVID-19 pandemic. Demographic characteristics and outcomes, including breastfeeding at discharge and length of stay were similar pre and post-onset of the COVID-19 pandemic. Post-rounding surveys by 10 (response rate 83%) neonatologists indicated parents were present in 80 (77%) of rounds and video was at least somewhat helpful in 94% of cases. Cross-sectional survey responses of 23 neonatologists and APPs (response rate 62%) indicated satisfaction with the program. Common themes on qualitative analysis of open-ended survey responses were "need for goodness of fit", and "another set of eyes" and "opportunities for use". CONCLUSION Daily telerounding with neonatologists and APPs in a Level II NICU supported neonatal care. Quality metrics and clinical outcomes are described with no differences seen before and during the COVID-19 pandemic.
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Affiliation(s)
- Christine Cooper
- Neonatology Regional Program, Seattle Children's Hospital, Seattle, United States
| | - Rossella Mastroianni
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, United States
| | - Elena Bosque
- Neonatology Regional Program, Seattle Children's Hospital, Seattle, United States
| | - Shilpi Chabra
- University of Washington, Seattle, United States
- Seattle Children's Hospital, Seattle, United States
| | - Julie Campbell
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, United States
| | - Jose Antonio Perez
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, United States
- Seattle Children's Hospital, Seattle, United States
| | - Cailin F White
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, United States
| | | | - Rachel A Umoren
- Pediatrics, University of Washington School of Medicine, Seattle, United States
- Seattle Children's Hospital, Seattle, United States
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Kidd VD, Hammonds J. The Perceived Impact of the New Medicare Rules for Split/Shared Visits: A Survey of Advanced Practice Administrators. Cureus 2023; 15:e40815. [PMID: 37363121 PMCID: PMC10287091 DOI: 10.7759/cureus.40815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background The Centers for Medicare and Medicaid Services (CMS) recently updated its split/shared policy but delayed enforcing sole time-based billing methodology in 2023 after industry pushback. However, the new time-based requirement is set for 2024. Yet, there is no published literature addressing perceived organizational impacts associated with new split/shared rules. Methods A cross-sectional survey study was administered via electronic email Listserv (n = 108) over a two-and-a-half-week period in 2023. The survey was conducted to examine the potential organizational impact of complying with the new Medicare split/shared visit policy. The collected survey data were analyzed using descriptive statistics. Results Despite the small sample size, this novel research study seems to suggest that there is a range of perceived issues associated with the new split/shared rules, including a perceived decrease in physician compensation due to changes in work relative value unit (wRVU) attribution and potential conflict between physicians and advanced practice providers (APPs) as they compete for wRVU credit for inpatient services. Additionally, respondents felt that the new regulatory change would lead to layoffs and/or hiring freezes of inpatient APP positions, thereby impacting team-based care dynamics. Further work is needed to better understand the impact of the new split/shared rules on coding practices, revenue, efficiency, provider, and patient satisfaction. Conclusion The findings reported in this study shed new light on the perceived impacts of the new split/shared visit rules on healthcare institutions. Although the updated rules are designed to provide greater transparency and better align reimbursement with services performed, concerns persist around the potential impact on day-to-day workflows, physician compensation, net revenue, and potential economic impact on the traditional team-based care model.
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Affiliation(s)
- Vasco Deon Kidd
- Department of Orthopedic Surgery, University of California, Irvine, School of Medicine, Orange, USA
| | - Jennifer Hammonds
- Office of Compliance and Privacy, University of California, Irvine, Orange, USA
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Buchholz T, Barzola M, Tayban Y, Halpern NA. A Rapid Response Team (RRT) System at a Cancer Center: Innovative Approaches to System Organization and Clinical RRT Pathways. Crit Care Nurs Q 2023; 46:116-125. [PMID: 36823738 PMCID: PMC10351879 DOI: 10.1097/cnq.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The Rapid Response Team (RRT) system at Memorial Sloan Kettering Cancer Center led by critical care medicine (CCM) advanced practice providers (APPs) expanded exponentially between 2009 and 2021. CCM-APPs are trained for care of critically ill patients as well as to oversee rapid response calls. The RRT is composed of a CCM-based RRT-APP, respiratory therapist, RRT-RN, and nursing supervisor. Since program inception, 11 RRT pathways and interventions have been developed and adjusted to improve multidisciplinary patient management. Pathways vary in complexity and require multidisciplinary collaboration. In some circumstances, the RRT patient may require transfer to outside facilities for services not provided at our oncology-based facility. RRT data are tracked across the hospital continuum with on-line reporting through RRT website dashboards. 2021 RRT data on electronic sepsis alerts, behavioral RRT and stroke alerts are presented. The RRT program is monitored through robust quality assurance. The APP-led RRT system's scope of care has been continuously expanded through the creation of RRT pathways to meet the increasingly complex medical needs of our patients.
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Affiliation(s)
- Tara Buchholz
- Memorial Sloan Kettering Cancer Center, New York, New York
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Felix HM, Cowdell JC, Paulson MR, Maita KC, Dugani SB, Avila FR, Torres-Guzman RA, Forte AJ, Matcha GV, Maniaci MJ. Impact of an Acquisition Advanced Practice Provider on Home Hospital Patient Volumes and Length of Stay. Healthcare (Basel) 2023; 11:healthcare11030282. [PMID: 36766857 PMCID: PMC9914253 DOI: 10.3390/healthcare11030282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
In July 2020, Mayo Clinic introduced a hospital-at-home program, known as Advanced Care at Home (ACH) as an alternate option for clinically stable medical patients requiring hospital-level care. This retrospective cohort study evaluates the impact of the addition of a dedicated ACH patient acquisition Advanced Practice Provider (APP) on average length of stay (ALOS) and the number of patients admitted into the program between in Florida and Wisconsin between 6 July 2020 and 31 January 2022. Patient volumes and ALOS of 755 patients were analyzed between the two sites both before and after a dedicated acquisition APP was added to the Florida site on 1 June 2021. The addition of a dedicated acquisition APP did not affect the length of time a patient was in the emergency department or hospital ward prior to ACH transition (2.91 days [Florida] vs. 2.59 days [Wisconsin], p = 0.22), the transition time between initiation of the ACH consult to patient transfer home (0.85 days [Florida] vs. 1.16 days [Wisconsin], p = 0.28), or the total ALOS (6.63 days [Florida] vs. 6.34 days [Wisconsin], p = 0.47). The average number of patients acquired monthly was significantly increased in Florida (38.3 patients per month) compared with Wisconsin (21.6 patients per month) (p < 0.01). The addition of a dedicated patient acquisition APP resulted in significantly higher patient volumes but did not affect transition time or ALOS. Other hospital-at-home programs may consider the addition of an acquisition APP to maximize patient volumes.
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Affiliation(s)
- Heidi M. Felix
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Jed C. Cowdell
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, 1221 Whipple St, Eau Claire, WI 54701, USA
| | - Karla C. Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | | | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Gautam V. Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
- Correspondence: ; Tel.: +904-956-0081; Fax: +904-953-2848
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Rosner CM, Lee SB, Badrish N, Maini AS, Young KD, Vorgang CM, Bagnola A, Desai SS, Hahndorf C, Looby M, Psotka MA, O'Connor CM, Cooper LB. Advanced Practice Provider Urgent Outpatient Clinic for Patients With Decompensated Heart Failure. J Card Fail 2022; 29:536-539. [PMID: 36526217 DOI: 10.1016/j.cardfail.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022]
Affiliation(s)
| | - Seiyon Ben Lee
- Department of Statistics, George Mason University, Fairfax, Virginia
| | | | - Aneel S Maini
- Georgetown University Medical School, Washington, D.C
| | - Karl D Young
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Aaron Bagnola
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Mary Looby
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Lauren B Cooper
- Inova Heart and Vascular Institute, Falls Church, Virginia; Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York
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Dugani SB, Kiliaki SA, Nielsen ML, Coons TJ, Fischer KM, Parikh RS, Pagali SR, Liwonjo A, Schroeder DR, Croghan IT, Burton MC. Post-discharge early assessment with remote video link (PEARL) initiative for patients discharged from hospital medicine services. Hosp Pract (1995) 2022; 50:379-386. [PMID: 36107464 PMCID: PMC9691619 DOI: 10.1080/21548331.2022.2125726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The COVID-19 pandemic impacted the availability and accessibility of outpatient care following hospital discharge. Hospitalists (physicians) and hospital medicine advanced practice providers (HM-APPs) coordinate discharge care of hospitalized patients; however, it is unknown if they can deliver post-discharge virtual care and overcome barriers to outpatient care. The objective was to develop and provide post-discharge virtual care for patients discharged from hospital medicine services. METHODS We developed the Post-discharge Early Assessment with Remote video Link (PEARL) initiative for HM-APPs to conduct a post-discharge video visit (to review recommendations) and telephone follow-up (to evaluate adherence) with patients 2-6 days following hospital discharge. Participants included patients discharged from hospital medicine services at an institution's hospitals in Rochester (May 2020-August 2020) and Austin (November 2020-February 2021) in Minnesota, US. HM-APPs also interviewed patients about their experience with the video visit and completed a survey on their experience with PEARL. RESULTS Of 386 eligible patients, 61.4% were enrolled (n = 237/386) including 48.1% women (n = 114/237). In patients with complete video visit and telephone follow-up (n = 141/237), most were prescribed new medications (83.7%) and took them as prescribed (93.2%). Among five classes of chronic medications, patient-reported adherence ranged from 59.2% (narcotics) to 91.5% (anti-hypertensives). Patient-reported self-management of 12 discharge recommendations ranged from 40% (smoking cessation) to 100% (checking rashes). Patients reported benefit from the video visit (agree: 77.3%) with an equivocal preference for video visits over clinic visits. Among HM-APPs who responded to the survey (88.2%; n = 15/17), 73.3% reported benefit from visual contact with patients but were uncertain if video visits would reduce emergency department visits. CONCLUSION In this novel initiative, HM-APPs used video visits to provide care beyond their hospital role, reinforce discharge recommendations for patients, and reduce barriers to outpatient care. The effect of this initiative is under evaluation in a randomized controlled trial.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Megan L. Nielsen
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Trevor J. Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Riddhi S. Parikh
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Anne Liwonjo
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Lake City, MN
| | | | - Ivana T. Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Department of Medicine, Clinical Research Office, Mayo Clinic, Rochester, MN
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14
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Navanandan N, McNulty MC, Suresh K, Freeman J, Scherer LD, Tyler A. Factors Associated With Clinician Self-Reported Resource Use in Acute Care and Ambulatory Pediatrics. Clin Pediatr (Phila) 2022; 62:329-337. [PMID: 36199256 PMCID: PMC10073349 DOI: 10.1177/00099228221128074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study is to determine predictors of resource use among pediatric providers for common respiratory illnesses. We surveyed pediatric primary care, emergency department (ED)/urgent care (UC), and hospital medicine providers at a free-standing children's hospital system. Five clinical vignettes assessed factors affecting resource use for upper respiratory infections, bronchiolitis, and pneumonia, including provider-type, practice location, tolerance to uncertainty, and medical decision-making behaviors. The response rate was 75.3% (168/223). The ED/UC and primary care providers had higher vignette scores, indicating higher resource use, compared with inpatient providers; advanced practice providers (APPs) had higher vignette scores compared with physicians. In multivariate analysis, being an ED/UC provider, an APP, and greater concern for bad outcomes were associated with higher vignette scores. Overall, provider type and location of practice may predict resource use for children with respiratory illnesses. Interventions targeted at test-maximizing providers may improve quality of care and reduce resource burden.
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Affiliation(s)
- Nidhya Navanandan
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Monica C McNulty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Krithika Suresh
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA.,Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
| | - Julia Freeman
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura D Scherer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Tyler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA.,Section of Pediatric Hospital Medicine, Children's Hospital of Colorado, Aurora, CO, USA
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15
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Muacevic A, Adler JR. An Evaluation of the Postgraduate Physician Assistant/Associate and Nurse Practitioner Orthopedic Surgery Fellowship and Residency Websites in the United States. Cureus 2022; 14:e29875. [PMID: 36348842 PMCID: PMC9629819 DOI: 10.7759/cureus.29875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Although considerable research on physician fellowship training program websites has demonstrated critical deficiencies in accessibility and content, there is no published study regarding the website content of physician assistant/associate (PA) and nurse practitioner (NP) orthopedic surgery postgraduate residency/fellowship programs in the United States. Therefore, this study aims to conduct a web-based content analysis to assess the available information on program websites and identify the potential areas for improvement. Methods The methodology for this study was replicated from prior research on graduate medical education (GME) websites. Twenty-two PA and joint PA/NP orthopedic surgery postgraduate residency/fellowship training program websites were assessed between August and September 2022. The criteria comprised 17 items related to postgraduate education and recruitment content. All program websites were evaluated for pertinent content relevant to prospective applicants applying to orthopedic surgery residency/fellowship programs. Descriptive statistics were performed. Results Out of the 22 PA and joint PA/NP orthopedic postgraduate websites evaluated, all had a functional website link. Only one orthopedic surgery postgraduate website met all 17 criteria. All program websites assessed contained program descriptions and contact information. Other information present on websites included program admission requirements 95% (21/22), salary/benefits 77% (17/22), interview requirement 73% (16/22), faculty listing 68% (15/22), journal club 59% (13/22), program objectives/goals 59% (13/22), and acceptance process 54% (12/22). Less than half of the program websites contained the following information: listing of current PA/NP postgraduate trainees, sample rotation schedule, orientation activities, curriculum, wellness/well-being strategy, graduation and research requirements, and link to program handbook. However, accredited PA orthopedic surgery program websites contained more content relevant to prospective applicants than non-accredited programs. Conclusion This is the first study to provide a detailed analysis of PA and joint PA/NP postgraduate orthopedic surgery residency/fellowship program websites. Not surprisingly, there is a wide variation in the available content on these websites. Study results provide further evidence to support the urgent need to improve program website content for prospective applicants.
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16
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Haggerty KL, Campetti R, Stoeckle RJ, Epstein-Lubow G, Evertson LC, Spragens L, Serrano KS, Jennings LA, Reuben DB. Dissemination of a successful dementia care program: Lessons from early adopters. J Am Geriatr Soc 2022; 70:2677-2685. [PMID: 35553424 PMCID: PMC9489618 DOI: 10.1111/jgs.17887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/14/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence-based models for providing effective and comprehensive care for Alzheimer's disease and related dementias exist but have yet to be successfully implemented at scale. The Alzheimer's and Dementia Care Program (ADC Program) is an effective comprehensive dementia care model that is being disseminated across the United States. This qualitative study examines barriers and facilitators to implementing the model among early adopting sites. METHODS This study included semi-structured interviews with a total of 21 clinical site leaders and Dementia Care Specialists from a total of 11 sites across the US. Interviews were audio recorded, transcribed, and coded using Dedoose qualitative analysis software. Coding scheme development and data interpretation were informed by Rogers' Diffusion of Innovations framework. RESULTS Key themes are organized in line with Rogers' framework. These include: the innovation-decision process, implementation and characteristics of the innovation, and sustainability. CONCLUSIONS Across the three overarching themes presented in this manuscript, the importance of engagement from site leaders, the multifaceted nature of the dementia care specialist role, and the value of technical assistance from qualified experts are apparent. However, for this work to continue to be successful, there needs to be more appropriate payment to cover needed services and a mechanism for supporting comprehensive dementia care over time.
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Affiliation(s)
| | - Randi Campetti
- Education Development Center, Inc, Waltham, Massachusetts, USA
| | | | - Gary Epstein-Lubow
- Education Development Center, Inc, Waltham, Massachusetts, USA
- Department of Pscyhiatry and Human Behavior, Alpert Medical School of Brown, University, Providence, Rhode Island, USA
| | - Leslie Chang Evertson
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Lynn Spragens
- Spragens & Associates, LLC, Durham, North California, USA
| | - Katherine Sy Serrano
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Lee A. Jennings
- Section of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David B. Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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17
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Periyakoil VS, von Gunten CF, Bailey FA, Dingfield LE, Schlögl M. Mid-Career Training to Advance Palliative Care. J Palliat Med 2022; 25:705-711. [PMID: 35499371 PMCID: PMC9271329 DOI: 10.1089/jpm.2022.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The demand for specialist palliative medicine physicians, advanced practice providers, and other team members outstrips supply. Traditional paths to specialty practice will not meet projected need. Therefore, innovation and research are required. One innovation is the training of midcareer professionals; those who have been in practice and want to change to palliative care. Barriers to leaving practice and returning to traditional training are high; not the least of which is the opportunity cost. In this roundtable, experts discuss what they have learned from current research, and point the way to additional needed research.
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA.,Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - F Amos Bailey
- Department of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura E Dingfield
- Perlman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathias Schlögl
- University Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zürich, Switzerland
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18
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Dugani SB, Fischer KM, Geyer HL, Maniaci MJ, Croghan IT, Burton MC. Psychologic wellness of PA, NP, and physician hospitalists during the COVID-19 pandemic. JAAPA 2022; 35:45-53. [PMID: 35421872 PMCID: PMC9129920 DOI: 10.1097/01.jaa.0000824964.37126.d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hospitalists, comprising PAs, NPs, and physicians, manage patients hospitalized with COVID-19. To guide the development of support programs, this study compared the psychologic wellness of hospitalist PAs, NPs, and physicians during the COVID-19 pandemic. METHODS We surveyed hospitalists in 16 hospitals at Mayo Clinic, from May 4 to 25, 2020. We used PROMIS surveys for self-reported global well-being (two single-item measures), anxiety, social isolation, and emotional support, before and during the pandemic. Linear and logistic regression models were adjusted for personal and professional factors. RESULTS The response rate was 52.2% (N = 154/295). In adjusted linear regression models, the change in scores (before minus during pandemic) for anxiety, social isolation, and emotional support was similar for PAs and NPs compared with physicians. In adjusted logistic regression models, physicians, compared with PAs and NPs, had a higher odds of top global well-being for mental health (adjusted odds ratio [95% confidence interval]: 2.82 [1.12, 7.13]; P = .03) and top global well-being for social activities and relationships (adjusted odds ratio 4.08 [1.38, 12.08]; P = .01). CONCLUSIONS During the COVID-19 pandemic, global well-being was lower for PAs and NPs compared with physician hospitalists. These results can guide support programs for hospitalists.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Holly L. Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | | | - Ivana T. Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Department of Medicine, Clinical Research Office, Mayo Clinic, Rochester, MN
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Mariotto AB, Enewold L, Parsons H, Zeruto CA, Yabroff KR, Mayer DK. Workforce Caring for Cancer Survivors in the United States: Estimates and Projections of Utilization. J Natl Cancer Inst 2022; 114:837-844. [PMID: 35171249 DOI: 10.1093/jnci/djac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/15/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to quantify the extent and diversity of the cancer care workforce, beyond medical oncologists, to inform future demand, as the number of cancer survivors is expected to grow in the US. METHODS SEER-Medicare data was used to evaluate healthcare utilization of cancer survivors diagnosed between 2000-2014 and enrolled in fee-for-service Medicare Parts A and B and 65 years or older in 2008-2015. We calculated percentage of cancer survivors who saw each clinician specialty and their average annual number of visits in each phase of care. We projected the national number of individuals receiving care and number of annual visits by clinician specialty and phase of care through 2040. RESULTS Cancer survivors had higher care utilization in the first year after diagnosis and last year of life phases. During the initial year after cancer diagnosis, most survivors were seen for cancer-related care by a medical oncologist (59.1%), primary care provider (55.9%) and/or other cancer-treating physicians (42.2%). The percentage of survivors with cancer-related visits to each specialty declined after the first year after diagnosis, plateauing after year 6-7. However, at 10 or more years after diagnosis, about 20% of cancer survivors had visits to medical oncologists and an average of 4 visits a year. CONCLUSIONS Cancer survivors had higher care utilization in the first year after diagnosis and last year of life. High levels of care utilization across specialty in all phases of care has important implications for models of survivorship care coordination and workforce planning.
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Affiliation(s)
- Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
| | - Lindsey Enewold
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
| | - Helen Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, US
| | | | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, US
| | - Deborah K Mayer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US.,School of Nursing, University of North Carolina Chapel Hill, Chapel Hill, NC, US.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, US
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21
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Abstract
Aim: Characterize current perceptions, practices, preferences and barriers to integrating pharmacogenomics into patient care at an institution with an established pharmacogenomics clinic. Materials & methods: A 16-item anonymous survey was sent to healthcare professionals practicing at Tampa General Hospital and the University of South Florida Health. Results: Survey participants consisted of nine advanced practice providers, 41 pharmacists and 64 physicians. Majority of survey participants did not feel confident in their ability to interpret and apply pharmacogenomic results. In the past 12 months, 27% of physicians reported ordering a pharmacogenomic test. The greatest reported barrier to integrating pharmacogenomics was the absence of established guidelines or protocols. Conclusion: Most clinicians believed pharmacogenomics would be useful in their clinical practice but do not feel prepared to interpret pharmacogenomic results.
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Affiliation(s)
- Teresa T Ho
- Department of Pharmacotherapeutics & Clinical Research, University of South Florida Taneja College of Pharmacy, Tampa, FL 33612, USA.,Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Maja Gift
- Department of Pharmacy Services, Tampa General Hospital, Tampa, FL 33601, USA
| | - Earnest Alexander
- Department of Pharmacy Services, Tampa General Hospital, Tampa, FL 33601, USA
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22
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Yalamanchi P, Blythe M, Gidley KS, Blythe WR, Waguespack RW, Brenner MJ. The Evolving Role of Advanced Practice Providers in Otolaryngology: Improving Patient Access and Patient Satisfaction. Otolaryngol Head Neck Surg 2021; 166:6-9. [PMID: 34154448 DOI: 10.1177/01945998211020314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Pratyusha Yalamanchi
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Kristi S Gidley
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Richard W Waguespack
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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23
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Armstrong WS. The Human Immunodeficiency Virus Workforce in Crisis: An Urgent Need to Build the Foundation Required to End the Epidemic. Clin Infect Dis 2021; 72:1627-1630. [PMID: 32211784 DOI: 10.1093/cid/ciaa302] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wendy S Armstrong
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
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24
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Patel S, Doerfler B, Boutros K, Ng S, Manuel M, DeSimone E. Review of Treatment Options for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation. Int J Gen Med 2021; 14:1457-1468. [PMID: 33907450 PMCID: PMC8071080 DOI: 10.2147/ijgm.s274568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/11/2021] [Indexed: 12/15/2022] Open
Abstract
Irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) are two common disorders of gut-brain interaction. Affected patients often first present to their primary care providers seeking care for symptoms of constipation, abdominal pain, and bloating, which have a significant impact on their health-related quality of life. These patients often require extensive counseling and reassurance, and knowledge of reliable diagnostic criteria and treatment options is imperative to managing their conditions. Family medicine practitioners, including nurse practitioners and physician assistants, are uniquely qualified to provide a diagnosis and safe, effective management of these disorders. This article reviews the latest evidence and provides practical advice related to diagnosis and management of IBS-C and CIC.
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Affiliation(s)
- Sarah Patel
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
- Rutgers University, Piscataway, NJ, USA
| | - Bethany Doerfler
- Division of Gastroenterology, Northwestern Medicine, Chicago, IL, USA
| | - Katerine Boutros
- Global Medical Affairs Gastroenterology & Hepatology, AbbVie Inc, Madison, NJ, USA
| | - Samson Ng
- Global Medical Affairs Gastroenterology & Hepatology, AbbVie Inc, Madison, NJ, USA
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25
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Dugani SB, Geyer HL, Maniaci MJ, Fischer KM, Croghan IT, Coons TJ, Canan EL, Burton MC. Hospitalist perspectives on barriers to recommend and potential benefit of the COVID-19 vaccine. Hosp Pract (1995) 2021; 49:245-251. [PMID: 33826433 DOI: 10.1080/21548331.2021.1914465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Hospitalists, comprised of nurse practitioners and physician assistants (collectively, advanced practice providers [APPs]) and physicians, have opportunities to counsel patients and reduce SARS-CoV-2 related coronavirus disease 2019 (COVID-19) vaccine hesitancy. However, hospitalist perspectives on the COVID-19 vaccine and potential differences between APPs and physicians are unknown. Understanding hospitalist perspectives could help to address vaccine hesitancy among patients.Methods: We conducted an online survey of hospitalists at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin from 14 December 2020 through 4 January 2021. We collected demographic information and assessed perspectives on the COVID-19 vaccine and, for comparison, on the influenza vaccine. Descriptive statistics were used to compare responses between APPs and physicians.Results: The overall response rate was 42.7% (n = 128/300) and comprised of 53.9% women (n = 69/128) and 41.4% APPs (n = 53/128). Most hospitalists reported receiving or planning to receive vaccination against COVID-19 (93.7%; n = 119/128) and influenza (97.7%; n = 125/128). Most hospitalists reported they would advise 100% of patients to receive the COVID-19 vaccine (66% for APPs; 74.7% for physicians) and influenza vaccine (83% for APPs; 80% for physicians). Barriers to recommending the COVID-19 vaccine included patient health status and vaccine safety profile. Hospitalists reported that patients and coworkers receiving the COVID-19 vaccine would reduce their anxiety (~80% of hospitalists), social isolation (~64% of hospitalists), and improve their emotional support (~40% of hospitalists). APP and physician responses were similar. The possible reduction in social isolation was associated with higher odds of hospitalists advising all patients to receive the COVID-19 vaccine (adjusted odds ratio 2.95 [95% confidence interval, 1.32-6.59]; P< .008), whereas hospitalist age, gender, and profession showed no association.Conclusion: Most hospitalists would reportedly advise patients to receive the COVID-19 vaccine. Barriers to this recommendation included patient health status and vaccine safety. Hospitalists are an important resource to provide patient education and reduce COVID-19 vaccine hesitancy.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Karen M Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ivana T Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Robert D. And Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Clinical Research Office, Mayo Clinic, Rochester, MN, USA
| | - Trevor J Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth L Canan
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Kamm AM, Liu JB, Demitroulas K, Devanagondi S, Acevedo J, Heitschmidt MG, Staffileno BA, Fogg L, Vondracek H. An interdisciplinary approach to safe opioid prescribing and administration for surgical patients at an academic medical center. J Clin Nurs 2020; 31:454-463. [PMID: 33179360 DOI: 10.1111/jocn.15561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/30/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023]
Abstract
AIM AND OBJECTIVES To explore and understand the current practice, perceptions, and knowledge of general surgery trainees, advanced practice providers, and surgical nurses regarding opioid prescribing and administration. To this end, a novel opioid education and training was introduced to educate these practitioners on safe opioid practices in surgical patients. BACKGROUND National awareness of the opioid epidemic has increased significantly in the last several years. However, there remain a disturbingly high number of opioid prescriptions written in the US indicating a need for improved provider and nurse education. This involves increasing awareness and understanding of national guidelines as well as implementing multi-modal therapy to treat pain. DESIGN Pre-post-intervention quality improvement project. METHODS An opioid education and training involving a morphine equivalent daily dosing calculator in the electronic medical record was provided to 26 surgical trainees, eight advanced practice providers and 97 surgical nurses in November 2019. Perceptions, current practice and knowledge were measured using a pre- and post-intervention survey (SQUIRE checklist). RESULTS The survey results showed a positive clinical change in perception of opioid use in surgical patients following the intervention and a modest decrease in the average morphine equivalent daily dosing at discharge in general and transplant surgery patients. CONCLUSIONS Effective pain management for surgical patients must be individualised. Safe opioid prescribing should involve an interdisciplinary approach with all members of the team undergoing assessment of their opioid knowledge and prescribing habits, easily accessible training tools and opioid calculators in the electronic medical record. RELEVANCE TO CLINICAL PRACTICE Our initiative may provide useful information to settings that replicate use of a morphine equivalent daily dosing calculator in the electronic medical record. Utilisation of safe opioid prescribing tools in the electronic medical record and continuing education for providers and nurses can help ensure the safety of surgical patients.
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Affiliation(s)
- Alaine M Kamm
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jason B Liu
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kristin Demitroulas
- Department of Nursing, University of Chicago Medicine, Chicago, Illinois, USA
| | - Shwetha Devanagondi
- Manager, Data and Analytics, University of Chicago Medicine, Chicago, Illinois, USA
| | - Julissa Acevedo
- Department for Research Informatics, University of Chicago Medicine, Chicago, Illinois, USA
| | - Mary G Heitschmidt
- College of Nursing, Rush University Medical Center, Chicago, Illinois, USA
| | - Beth A Staffileno
- College of Nursing, Rush University Medical Center, Chicago, Illinois, USA
| | - Louis Fogg
- College of Nursing, Rush University Medical Center, Chicago, Illinois, USA
| | - Hugh Vondracek
- College of Nursing, Rush University Medical Center, Chicago, Illinois, USA
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Gomez S, Anderson BJ, Yu H, Gutsche J, Jablonski J, Martin N, Kerlin MP, Mikkelsen ME. Benchmarking Critical Care Well-Being: Before and After the Coronavirus Disease 2019 Pandemic. Crit Care Explor 2020; 2:e0233. [PMID: 33134934 DOI: 10.1097/CCE.0000000000000233] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: Examine well-being, measured as burnout and professional fulfillment, across critical care healthcare professionals, ICUs, and hospitals within a health system; examine the impact of the coronavirus disease 2019 pandemic. Design: To complement a longitudinal survey administered to medical critical care physicians at the end of an ICU rotation, which began in May 2018, we conducted a cross-sectional survey among critical care professionals across four hospitals in December 2018 to January 2019. We report the results of the cross-sectional survey and, to examine the impact of the coronavirus disease 2019 pandemic, the longitudinal survey results from July 2019 to May 2020. Setting: Academic medical center. Subjects: Four-hundred eighty-one critical care professionals, including 353 critical care nurses, 58 advanced practice providers, 57 physicians, and 13 pharmacists, participated in the cross-sectional survey; 15 medical critical care physicians participated in the longitudinal survey through the coronavirus disease 2019 pandemic. Interventions: None. Measurements and Main Results: Burnout was present in 50% of ICU clinicians, ranging from 42% for critical care physicians to 55% for advanced practice providers. Professional fulfillment was less common at 37%, with significant variability across provider (p = 0.04), with a low of 23% among critical care pharmacists and a high of 53% among physicians. Well-being varied significantly at the hospital and ICU level. Workload and job demand were identified as drivers of burnout and meaning in work, culture and values of work community, control and flexibility, and social support and community at work were each identified as drivers of well-being. Between July 2019 and March 2020, burnout and professional fulfillment were present in 35% (15/43) and 58% (25/43) of medical critical care physician responses, respectively. In comparison, during the coronavirus disease 2019 pandemic, burnout and professional fulfillment were present in 57% (12/21) and 38% (8/21), respectively. Conclusions: Burnout was common across roles, yet differed across ICUs and hospitals. Professional fulfillment varied by provider role. We identified potentially modifiable factors related to clinician well-being that can inform organizational strategies at the ICU and hospital level. Longitudinal studies, designed to assess the long-term impact of the coronavirus disease 2019 pandemic on the well-being of the critical care workforce, are urgently needed.
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Sievers S, Watson G, Johncy S, Adkins S. Recognizing and Grading CAR T-Cell Toxicities: An Advanced Practitioner Perspective. Front Oncol 2020; 10:885. [PMID: 32670871 PMCID: PMC7327099 DOI: 10.3389/fonc.2020.00885] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/05/2020] [Indexed: 12/30/2022] Open
Abstract
Over the past decade, chimeric antigen receptor (CAR) T-cell therapy has significantly improved the outlook for many patients with relapsed and/or refractory B-cell malignancies. The use of CAR T-cell therapy and other therapeutic immune effector cells will likely continue to expand with the development of other targets and use in solid tumors. Although these therapies have shown significant promise in the treatment of some malignancies, they can be associated with unique toxicities including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome which can be fatal if not identified early and treated appropriately. An understanding of how best to manage the toxicities associated with CAR T-cell therapy is continually evolving. Institutions providing CAR T-cell therapy have undergone changes in infrastructure and staffing models in order to safely care for patients receiving this novel therapy. As members of a multi-disciplinary health care team, advanced practice providers play significant roles in caring for this patient population and must be well-versed in the recognition, grading, and appropriate management of CAR T-cell therapy-related toxicities as these providers care for patients in multiple settings across the continuum of care.
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Affiliation(s)
- Savannah Sievers
- Department of Physician Assistant Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace Watson
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Swapna Johncy
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sherry Adkins
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Harris GH, Baldisseri MR, Reynolds BR, Orsino AS, Sackrowitz R, Bishop JM. Design for Implementation of a System-Level ICU Pandemic Surge Staffing Plan. Crit Care Explor 2020; 2:e0136. [PMID: 32695999 DOI: 10.1097/CCE.0000000000000136] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The current coronavirus disease 2019 pandemic is causing significant strain on ICUs worldwide. Initial and subsequent regional surges are expected to persist for months and potentially beyond. As a result of this, as well as the fact that ICU provider staffing throughout the United States currently operate at or near capacity, the risk for severe and augmented disruption in delivery of care is very real. Thus, there is a pressing need for proactive planning for ICU staffing augmentation, which can be implemented in response to a local surge in ICU volumes. Methods: We provide a description of the design, dissemination, and implementation of an ICU surge provider staffing algorithm, focusing on physicians, advanced practice providers, and certified registered nurse anesthetists at a system-wide level. Results: The protocol was designed and implemented by the University of Pittsburgh Medical Center’s Integrated ICU Service Center and was rolled out to the entire health system, a 40-hospital system spanning Pennsylvania, New York, and Maryland. Surge staffing models were developed using this framework to assure that local needs were balanced with system resource supply, with rapid enhancement and expansion of tele-ICU capabilities. Conclusions: The ICU pandemic surge staffing algorithm, using a tiered-provider strategy, was able to be used by hospitals ranging from rural community to tertiary/quaternary academic medical centers and adapted to meet specific needs rapidly. The concepts and general steps described herein may serve as a framework for hospital and other hospital systems to maintain staffing preparedness in the face of any form of acute patient volume surge.
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Knapp K, Ignoffo R. Oncology Pharmacists Can Reduce the Projected Shortfall in Cancer Patient Visits: Projections for Years 2020 to 2025. Pharmacy (Basel) 2020; 8:E43. [PMID: 32197351 DOI: 10.3390/pharmacy8010043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/24/2022] Open
Abstract
Based on the projected need for a larger oncology care workforce, we estimated the patient care visits and care activities that Board Certified oncology pharmacists (BCOPs) could contribute to oncology care from 2020–2025. Using projected counts for BCOPs through 2025, we estimated that 2.9–4.1 million 30-min BCOP patient visits were possible at 50% workforce capacity. BCOPs’ clinical activities overlapped strongly with those of nurse practitioners (NPs) and physician assistants (PAs) in patient education and treatment management. BCOPs could help reduce provider stress and burnout concerns by spreading these activities across a broader set of providers. BCOPs were more active than NPs and PAs in clinical trials research. Recent advances in immunotherapy, pharmacogenetics, pharmacogenomics, and oral oncolytic agents make the medication-focused training of OPs particularly useful to care teams. Comparison also showed that BCOPs were less active in providing follow-up visits and prescribing. Fulfilling the projected BCOP numbers through 2025 will require continued growth in Postgraduate Year 2 (PGY2) oncology pharmacy resident programs and on-the-job training programs. Our review of the trends in cancer incidence, mortality, and survivorship suggest a sustained need for the activities of BCOPs and other oncology care providers.
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Bates RE, Kesselring GM, Breunig MJ, Rieck KM. Overnight cross-coverage on hospital medicine services: perceived workload based on patient census, pager volumes, and patient acuity. Hosp Pract (1995) 2020; 48:108-112. [PMID: 32160480 DOI: 10.1080/21548331.2020.1741951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/10/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Little is understood about what contributes to perceived workload for those providing overnight coverage to hospitalized patients overnight, which limits the ability to modify these factors or to proactively identify appropriate staffing levels. The objective of this study is to understand the major contributors to perceived overnight cross-coverage workload. METHODS Cross-covering advanced practice providers (APPs) in a large academic hospitalist group completed the National Aeronautics and Space Administration Task Load Index (NASA-TLX) at the end of each night shift. Other shift characteristics were collected, including patient load, assigned action items, watcher/unstable patients, newly admitted patients, number of units covered, total pages, peak pager density, rapid response team (RRT) activations, and intensive care unit (ICU) transfers. RESULTS For 14 APP participants, who completed 271 post-shift surveys, the mean (SD) patient load was 49.9 (6.4) patients per night, and providers received a mean (SD) of 40.8 (13.7) total pages per shift. Mean (SD) NASA-TLX score was 35.1 (19.0). In multivariate modeling, total pages, action items, and any RRT or ICU transfer were associated with significant increases in the mean NASA-TLX score, with estimated effect sizes of 0.5, 0.8, and 14.3, respectively, per 1-unit increase in each shift characteristic. The greatest cumulative contributor to perceived workload was total number of pages, followed by the presence of any RRT activation/ICU transfer, with estimated effect sizes of 20.4 and 14.9, respectively. CONCLUSIONS Total number of pages was the greatest contributor to perceived workload. This study suggests that quality improvement initiatives designed to improve pager communication may considerably improve provider-perceived workload.
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Affiliation(s)
- Ruth E Bates
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | - Gina M Kesselring
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | - Michael J Breunig
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | - Katie M Rieck
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
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Bruinooge S, Pickard TA, Vogel W, Hanley A, Schenkel C, Garrett-Mayer E, Tetzlaff E, Rosenzweig M, Hylton H, Westin SN, Smith N, Lynch C, Kosty MP, Williams SF. Understanding the Role of Advanced Practice Providers in Oncology in the United States. Oncol Nurs Forum 2019; 45:786-800. [PMID: 30339144 DOI: 10.1188/18.onf.786-800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims to identify all oncology APPs and 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. 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.
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Rymer JA, Chen AY, Thomas L, Stafford J, Enriquez JR, Goyal A, Peterson ED, Wang TY. Advanced Practice Provider Versus Physician-Only Outpatient Follow-Up After Acute Myocardial Infarction. J Am Heart Assoc 2018; 7:e008481. [PMID: 30371165 PMCID: PMC6201421 DOI: 10.1161/jaha.117.008481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
Background Physician shortages and reimbursement changes have led to greater use of advanced practice providers ( APP s). Prevalence of and outcomes associated with APP care following myocardial infarction are unknown. Methods and Results We examined outpatient cardiology or primary care visits within 90 days post-myocardial infarction among 29 477 Medicare-insured patients aged ≥65 years from 364 hospitals in Acute Coronary Treatment Intervention Outcomes Network Registry. We compared medication adherence, all-cause readmission risk, mortality, and major adverse cardiovascular events between patients seen by APP s versus physicians only. Overall, 11% of myocardial infarction patients were treated by an APP . Patients seen by APP s were more likely to have diabetes mellitus (37% versus 33%) and heart failure (20% versus 16%), be discharged to a nursing facility (21% versus 13%) and had more outpatient visits within 90 days post-discharge (median 6 versus 5, P<0.01 for all) than those seen by physicians only. Adherence to evidence-based medications (adjusted odds ratio, 0.98; 95% confidence interval, 0.89-1.08) and readmission risks (adjusted hazard ratio, 1.11; 95% confidence interval, 0.99-1.26) were similar between patients seen by APP s versus physicians only. Risks of 90-day mortality (adjusted hazard ratio, 1.18; 95% confidence interval, 0.98-1.42) and major adverse cardiovascular events (adjusted hazard ratio, 1.06; 95% confidence interval, 0.90-1.23) were also similar between patients seen by APP s versus physicians only. Conclusions APP s were likely used to provide more frequent monitoring of high-risk post- MI patients. Medication adherence, readmission risk, mortality, and major adverse cardiovascular events did not differ substantially between patients seen by physician- APP teams than those seen by physicians only.
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Kang R, Columbo JA, Kunkel ST, Stucke RS, Sabatino MJ, Tang A, Goodney PP, Rosenkranz KM. Residents' Impressions of the Impact of Advanced Practice Providers on Surgical Training. J Am Coll Surg 2018; 226:1036-1043. [PMID: 29224796 PMCID: PMC10723757 DOI: 10.1016/j.jamcollsurg.2017.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To ensure that residents are appropriately trained in the era of the 80-hour work-week, training programs have restructured resident duties and hired advanced practice providers (APPs). However, the effect of APPs on surgical training remains unknown. STUDY DESIGN We created a survey using a modified Delphi technique to examine the interaction between residents and APPs across practice settings (inpatient, outpatient, and operating room). We identified the following domains: administrative tasks, clinical experience, operative experience, and overall impressions. We administered the survey to residents across 7 surgical training programs at a single institution and assessed internal reliability with Cronbach's α. RESULTS Fifty residents responded (77% participation rate). The majority reported APPs reduced the time spent on administrative tasks, such as completing documentation (96%) and answering pages (88%). For clinical experience, 62% of residents thought that APPs had no impact on the amount of time spent evaluating consult patients, and 80% reported no difference in the number of bedside procedures performed. However, 77% of residents reported a reduction in the time spent counseling patients. When APPs worked in the inpatient setting, 90% of residents reported leaving the operating room less frequently to manage patients. When APPs were present in the operating room, 34% of residents thought they were less likely to perform key parts of the case. Cronbach's α showed excellent to good reliability for the administrative tasks (0.96), clinical experience (0.76), operative experience (0.69), and overall impressions (0.66) domains. CONCLUSIONS Most residents report that the integration of APPs has decreased the administrative burden. The reduction in patient counseling might be an unrecognized and unintended consequence of implementing APPs. The perceived effect on operative experience is dependent on the role of the APPs.
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Affiliation(s)
- Ravinder Kang
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH; Veterans Affairs Outcomes Group, White River Junction, VT.
| | - Jesse A Columbo
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH; Veterans Affairs Outcomes Group, White River Junction, VT
| | - Samuel T Kunkel
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Ryland S Stucke
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Matthew J Sabatino
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Austin Tang
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Philip P Goodney
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH; Veterans Affairs Outcomes Group, White River Junction, VT
| | - Kari M Rosenkranz
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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