A multidisciplinary care model to increase access to neurologic ambulatory care.
Journal
Journal of the American Association of Nurse Practitioners
ISSN: 2327-6924
Titre abrégé: J Am Assoc Nurse Pract
Pays: United States
ID NLM: 101600770
Informations de publication
Date de publication:
29 Jun 2020
29 Jun 2020
Historique:
received:
17
01
2020
accepted:
27
03
2020
entrez:
10
3
2021
pubmed:
11
3
2021
medline:
25
11
2021
Statut:
epublish
Résumé
Expert patient care has been associated with improved outcomes for neurology patients, yet timely access to specialists is challenging. The employment of nurse practitioners (NPs) holds great potential to increase access to neurologic ambulatory care, however little practical guidance exists to date for how this may be achieved. To improve timely care provision for patients with neurologic disease, we employed a multidisciplinary care utilization framework that used NPs to expand clinic appointment availability. After evaluating our baseline performance, we applied a standardized approach to the deployment of NPs in neurology clinic with regard to scheduling clinic sessions and patient appointments. The primary outcome measure was appointment availability measured over 6 months preintervention (June to November 2016) and 6 months postintervention (June to November 2017). Secondary measures included NP effort allocation. The postintervention period demonstrated an increase in available appointments (3,731 preintervention vs. 4,318 postintervention) and scheduled appointments (2,014 vs. 2,685). Nurse practitioners spent more time practicing at the fullest extent of their licensure. All improvements were accomplished without the hiring of additional staff. A multidisciplinary care utilization framework for NP employment across neurology subspecialties resulted in an increase in appointment availability. Furthermore, this model is likely to be sustainable due to provider satisfaction and financial viability.
Sections du résumé
BACKGROUND
BACKGROUND
Expert patient care has been associated with improved outcomes for neurology patients, yet timely access to specialists is challenging. The employment of nurse practitioners (NPs) holds great potential to increase access to neurologic ambulatory care, however little practical guidance exists to date for how this may be achieved.
LOCAL PROBLEM
OBJECTIVE
To improve timely care provision for patients with neurologic disease, we employed a multidisciplinary care utilization framework that used NPs to expand clinic appointment availability.
METHODS AND INTERVENTION
METHODS
After evaluating our baseline performance, we applied a standardized approach to the deployment of NPs in neurology clinic with regard to scheduling clinic sessions and patient appointments. The primary outcome measure was appointment availability measured over 6 months preintervention (June to November 2016) and 6 months postintervention (June to November 2017). Secondary measures included NP effort allocation.
RESULTS
RESULTS
The postintervention period demonstrated an increase in available appointments (3,731 preintervention vs. 4,318 postintervention) and scheduled appointments (2,014 vs. 2,685). Nurse practitioners spent more time practicing at the fullest extent of their licensure. All improvements were accomplished without the hiring of additional staff.
CONCLUSIONS
CONCLUSIONS
A multidisciplinary care utilization framework for NP employment across neurology subspecialties resulted in an increase in appointment availability. Furthermore, this model is likely to be sustainable due to provider satisfaction and financial viability.
Identifiants
pubmed: 33690259
doi: 10.1097/JXX.0000000000000435
pii: 01741002-202103000-00012
doi:
Types de publication
Journal Article
Langues
eng
Pagination
254-259Informations de copyright
Copyright © 2020 American Association of Nurse Practitioners.
Déclaration de conflit d'intérêts
Competing interests: The authors report no conflicts of interest.
Références
Black S. B., Pearlman S. B., Khoury C. K. (2016). Adding an advanced practice provider to a neurology practice: Introduction to outpatient and inpatient models. Neurology: Clinical Practice, 6, 538–542.
Busis N. A., Shanafelt T. D., Keran C. M., Levin K. H., Schwarz H. B., Molano J. R., Vidic T. R., Kass J. S., Miyasaki J. M., Sloan J. A., Cascino T. L. (2017). Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology, 88, 797–808.
Coberly S. (2015). Relative value units (RVUs). National Health Policy Forum.
Dall T. M., Storm M. V., Chakrabarti R., Drogan O., Keran C. M., Donofrio P. D., Henderson V. W., Kaminski H. J., Stevens J. C., Vidic T. R. (2013). Supply and demand analysis of the current and future US neurology workforce. Neurology, 81, 470–478.
Freeman W. D., Vatz K. A., Griggs R. C., Pedley T. (2013). The Workforce Task Force report: Clinical implications for neurology. Neurology, 81, 479–486.
Gudbranson E., Glickman A., Emanuel E. J. (2017). Reassessing the data on whether a physician shortage exists. JAMA, 317, 1945–1946.
Hill C. E., Thomas B., Sansalone K., Davis K. A., Shea J. A., Litt B., Dahodwala N. (2017). Improved availability and quality of care with epilepsy nurse practitioners. Neurology: Clinical Practice, 7, 109–117.
Hoff T., Carabetta S., Collinson G. E. (2019). Satisfaction, burnout, and turnover among nurse practitioners and physician assistants: A review of the empirical literature. Medical Care Research and Review, 76, 3–31.
Horrocks S., Anderson E., Salisbury C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ: British Medical Journal, 324, 819–823.
Moote M., Krsek C., Kleinpell R., Todd B. (2011). Physician assistant and nurse practitioner utilization in academic medical centers. American Journal of Medical Quality, 26, 452–460.
Morgenlander J. C., Blessing R. (2016). The Duke neurology advanced practice provider residency: Table. Neurology: Clinical Practice, 6, 277–280.
Ney J. P., Johnson B., Knabel T., Craft K., Kaufman J. (2016). Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset. Neurology, 86, 367–374.
Ross S. C. (2014). An option for improving access to outpatient general neurology. Neurology: Clinical Practice, 4, 435–440.
Schwarz H. B., Fritz J. V., Govindarajan R., Penfold Murray R., Boyle K. B., Getchius T. S. D., Freimer M. (2015). Neurology advanced practice providers: A position paper of the American Academy of Neurology. Neurology: Clinical practice, 5, 333–337.
Swan M., Ferguson S., Chang A., Larson E., Smaldone A. (2015). Quality of primary care by advanced practice nurses: A systematic review. International Journal for Quality in Health Care, 27, 396–404.
Willis A. W., Schootman M., Evanoff B. A., Perlmutter J. S., Racette B. A. (2011). Neurologist care in Parkinson disease: A utilization, outcomes, and survival study. Neurology, 77, 851–857.