THE POSITIVE IMPACT OF EXPANDING THE ROLE OF ADVANCED PRACTICE PROVIDERS IN HEAD AND NECK CANCER CARE

Presentation: S042
Topic: Value and Quality in H&N Surgery (Value-Based Care)
Type: Oral
Date: Thursday, April 27, 2017
Session: 1:00 PM - 2:00 PM Value-Based H&N Cancer Care
Authors: Emily Shindeldecker, NP, Kristen Johnson, MHA, Megan Adelman, PA, Laura Skoracki, PA, Stephanie Wigton, PA, Ann Onofri, NP, Steve Kang, MD, Theodoros Teknos, MD, Amit Agrawal, MD, James Rocco, MD, PhD, Enver Ozer, MD, Ricardo Carrau, MD, Matthew Old, MD
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Institution(s): The Ohio State University
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Introduction: Continued emphasis is being placed on improving quality metrics, particularly with health care reform.   Parallel to this, CMS and the insurance industry have redefined many surgeries that were traditionally inpatient as outpatient surgery.  The pressures of more outpatient surgeries and decreasing hospital length of stay drove our group to increase our head and neck advanced practice providers to assist in handling the volume and improving quality metrics.

Hypothesis: The expansion of head and neck advanced practice providers will result in improvements in quality metrics in a busy academic head and neck cancer practice.

Methods: A retrospective review of quality metrics before and after implementation of head and neck trained advanced practitioners (NP, PA, outpatient and inpatient) was collected from electronic medical record system and the quality metric collection system from 2009-2016.  Quality metrics included unplanned readmissions and average days to follow up from discharge were compared to outpatient volume, surgical volume, and provider availability. Metrics were compared before and after establishment of the advanced provider clinics.  Standard t-test analyses were performed to assess significance. 

Results: New outpatient visits increased 60% to over 2000 visits per year over the study period.  Total outpatient clinic visits increase 110% to over 15,000 visits per year over the same time frame.  Surgical volume increased by 50% to over 1800 cases in 2016. Outpatient surgical volume has shifted from 30% to over 60% over the study period.  The advanced practitioner clinic volume increased to over 1100 visits per year after establishment of the system.  Comparing the quality metrics before and after the system was established demonstrated significant improvements in readmission rates (down to 5% of total admissions).  Days to follow up after discharged decreased significantly from 12 to 9 days. 

Conclusion: The establishment of a head and neck advanced practitioner service has assisted in improving quality metrics despite the trend of shifting surgeries to the outpatient setting and increasing volume of a busy academic practice.

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