Conclusion and Implementation to Practice

1. Description of an Autonomous Nurse Practitioner Practice at an NCI designated Comprehensive Cancer Center (CCC) • Kristina Mathey, MS, RN, CNP, AOCNP®, David Efries, MSN, RN, CNP, Amanda Wagner, MS, RN, CNP, AOCNP®, Yahna Smith, MSN, RN, CNP, D. Kristine Harvey, MS, RN, CNP. • The Ohio State University Comprehensive Cancer Center-Arthur G James Cancer Hospital and Richard J Solove Research Institute The GI Medical Oncology NP Role Significance and Background Conclusion and Implementation to Practice Findings • Nurse Practitioners are in a unique position to positively impact the care of the oncology patient. • By utilizing the nurse practitioner at the highest level of functioning with independent run clinics, the physician clinics are able to be utilized for new patients and treatment plan decisions. • They also provide a significant practice revenue stream. • Having the Nurse Practitioner functioning at their highest level of autonomy within the team approach, we are able to maximize care throughout the continuum of the GI medical oncology patient. • Independently run Nurse Practitioner clinics • Multidisciplinary care coordination at the provider level • Unique and inter-dependent collaboration with the Disease Management Coordinators • Follows NCCN Clinical Practice Guidelines in Oncology • Uses evidence-based practice guidelines and assessment tools for evaluating and treating patients • Collaborates with the multidisciplinary team, patient, family, and caregivers to formulate a comprehensive plan of care • Assesses symptoms commonly seen in patients with GI cancer (e.g., fatigue, pain, nausea, vomiting) or its treatment (e.g. neuropathy, diarrhea, nausea/vomiting, fatigue) • Treats episodic, acute, and chronic health problems • Assesses for common signs and symptoms related to disease progression or recurrence Performs a comprehensive assessment of functional status and the impact on activities of daily living • Assesses for the presence of psychological co-morbidities (e.g., anxiety/depression, substance use) and the psychosocial impact of the cancer experience • Demonstrates awareness of appropriate clinical trials and research studies for which patients may be eligible and assists in recruiting patients as appropriate • Gastrointestinal (GI) cancers are cancers of the organs of the digestive system. • The estimated number of new gastrointestinal cancer cases totals more than 250,000 annually. • Due to improvements in prevention, early detection, and treatment, more Americans count themselves as survivors. • The population of survivors on active treatment and surveillance in oncology clinics is increasing and therefore, the need for follow-up and surveillance care is also increasing. • Because of this, the utilization of the Nurse Practitioner is invaluable. GI Medical Oncology Group saw >10,000 patients in FY 2012/2013: 47% were Independent NP visits Methods Patient Acuity by CPT coding FY2012/2013 • Utilized internal databases to query nurse practitioner measures of independence. • Collaborate with a multi-disciplinary team, including oncologists and specialized registered nurses functioning as disease management coordinators to formulate and manage a comprehensive plan of care. • The GI Nurse Practitioner independently runs a patient clinic with multidisciplinary care coordination at the provider level. • Employ evidence-based practice guidelines and assessment tools for evaluating and treating patients including episodic, acute and chronic health problems. Bibliography Buswell, L.A., Ponte, P.R., & Shulman, L.N. (2009). Provider Practice Models in Ambulatory Oncology Practice: Analysis of Productivity, Revenue, and Provider and Patient Satisfaction. Journal of Oncology Practice, 5(4). 188-192. Moote, M., Nelson, R., Veltkamp, R., & Campbell, D. (2012). Productivity Assessment of Physician Assistants and Nurse Practitioners in Oncology in an Academic Medical Center. Journal of Oncology Practice, 8, 167-172. doi:  10.1200/JOP.2011.000395 NP Revenue Generated in Dollars per Level of Service