Advance Practice Professional Practice Models-Where Do You Fit?

1. Advance Practice Professional Practice Models-Where Do You Fit? • Amanda Wagner, MS, RN, CNP, AOCNP®, Kristina Mathey, MS, RN, CNP, AOCNP®, David Efries, MSN, RN, CNP, • Yahna Smith, MSN, RN, CNP, D. Kristine Harvey, MS, RN, CNP. • The Ohio State University Wexner Medical Center-James Cancer Hospital and Solove Research Institute. Columbus, Ohio. • A Literature Review Shared Care Model Significance Mixed Model “Theory in Action” • The physician and APP selectively see patients independently or together, with neither independent or shared visits predominating. • APP works both in the shared care model and the independent model at different times. • Physician and APP see patient together. • Tasks may be divided but both providers see the patient • The physician may make recommendations regarding treatment or clinical status while the APP manages symptoms management , home care, and social support. • In the GI Medical Oncology clinic at The James Cancer Hospital in Columbus, Ohio, we function using a mixed model: • Patients are seen in the shared care model where they see both the APP and physician • Ex. A patient who needs a chemotherapy check and scan review • The APP also has scheduled independent run clinics • Ex. Patients seen for physical exams for clinical trials, chemotherapy toxicity check or survivorship visits • There is also a daily “flex” schedule • Ex. A patient may be scheduled on the physician’s schedule, but based on the needs of the physician and the day, the patient may be seen by the APP only • More people are being diagnosed with cancer every year. Therefore, the demands on oncologists continue to increase. • With new treatments and research advances, advanced practice professionals are being utilized more frequently. • There is great variability in the functioning of the Advance Practice Professional (APP) and there is not one standard practice model for their utilization. • As oncology care is becoming more complex and there is increased pressure to decrease cost while improving quality in health care, APPs must be used in a collaborative model. • While models vary from practice to practice, each provider and practice can look at these models and determine what fits and evolves best with their practice based on their experience and needs. Independent Model COLLABORATIVE PRACTICE MODELS BETWEEN PHYSICIAN AND APP • The providers, be it the APP or Physician, sees the patient independently • 2 variations: • Incident-to-Practice Model or Daily Flex Schedule • There is one schedule and the patient flexes between the providers based on the need • 2. Independent Model or Independent Schedule • When the APP sees patients independently when the physician is not in clinic • Patients are seen at separate times and the APP/Physician practices completely independently • The patient may be assigned to one or the other provider depending on the needs of the patient • The physician may see patient as a new patient or for follow-up restaging scans, while the APP will see the patient for survivorship or chemotherapy checks SHARED PRACTICE MODEL INDEPENDENT PRACTICE MODEL Benefits of Partnership in Oncology Care • Improved patient care • Increased clinical productivity • Improved access for patients • Urgent care • Survivorship • Increased Revenue • Coverage for the Academic Physician Bibliography Methods/Findings Buswell, L.A., Reid Ponte, P., & Shulman, L.N. (2009). Provider Practice in Ambulatory Oncology Practice:Analysis of Productivity, Revenue, and Provider and Patient Satisfaction. Journal of OncologyPractice, 5(4). 188-192. Doi: 10.1200/JOP.0942006. Liu, N., Finkelstein, S.R., & Poghosyan, L. (2014). A new model for nurse practitioner utilization in primary care: Increased efficiency and implications. Health Care Management Review,39 (1). 10-20. Doi: 10.1097/HMR.0b013e318276fadf. Shulman, L.N. (2013). Efficient and Effective Models for Integrating Advance Practice Professionals into Oncology Practice. American Society of Clinical Oncology Education Book. 377-379. Doi: 10. 1200/EdBook_AM.2013.33.e377. Towle, E.L., Barr, T.R., Hanley, A., Kosty, M., Williams, S., & Goldstein, M.A. (2011). Results of the ASCO Study of Collaborative Practice Arrangements. Journal of Oncology Practice, 7(5). 278-282.Doi: 10.1200/JOP.2011.000385. • Reviewed the literature on practice models in online databases of PubMed, CINHAL, and EBSCOhost Medline. • Four articles were found and reviewed. Three dominant models of care were found. Implications for Future Research • These models should be evaluated for: • Quality of care • Patient and/or provider satisfaction • Productivity and cost.