Abstract
Introduction: Much of oncology care is now delivered through a team approach; understanding the potential benefits of the physician/APP collaborative unit, in addition to the value of the APP individually, has never been more important. A recent study demonstrated that 54% of oncologists work collaboratively with advanced practice providers (APPs) such as physician assistants (PAs) and nurse practitioners (NP). At the Abramson Cancer Center (ACC) 83% of the MDs collaborate with an APP. With the widening gap between the demand for oncology services and available providers, it is estimated that these numbers will continue to increase. Despite this clear upward trend, there are not benchmark metrics specific to the oncology APP provider that can be utilized to represent the value of APPs as medical oncology professionals. At the ACC we were not using any metrics for our outpatient APPs. Each APP had only a yearly, multi page generic evaluation with subjective comments and scoring from their collaborating physicians and their direct supervisor. Description: A team of outpatient APPs formed a committee with the aim to search the literature for an applicable panel of APP driven metrics to use with our hem/onc division. The team included APPs from medical oncology, hematology-oncology, internal medicine, and radiation oncology. One of the barriers with developing these metrics was trying to assist our Information Technology (IT) staff to understand the nuances of APP practice patterns. Through this metrics group, we learned that our colleagues in radiation oncology had made progress in this area. After collaborating with radiation oncology’s IT specialist and our electronic medical record (EMR) IT specialists, our metrics group was able to better understand how to use and develop our own discrete elements within the EMR to represent our APP metrics. During and since our pilot, our IT support team has been integral in the implementation of revisions to our reports. A dashboard of evidence-based metrics was created for the APPs in the Hematology Oncology outpatient department at the ACC at the University of Pennsylvania. The metrics chosen represent four different aspects of APP practice. Each category contains 1-5 metrics. Electronic reports on the quality and patient volume metrics were created and generated for monthly, quarterly, and yearly review. The four categories are: patient satisfaction, quality metrics for independent and shared office visits, financial impact, and professional development. Patient satisfaction is gauged through Press Ganey reports for provider-specific encounters. Quality metrics include chart closure rate, allergy and medication reconciliation rate, documentation of smoking status and plan for smoking cessation, and documentation of pain and plan for management of pain. Financial impact includes total practice volume, APP independent visit volume, shared visit volume, total billing charges/RVUs. Professional development includes publications, presentations, participation in research or cancer center/hospital-based quality improvement committees, mentorship, continuing education credits, conference attendance, scholarships/grants/awards or pursuing an advanced degree. Summary:
It is important to measure and show the quality of our care and our productivity within collaborative oncology practices. Creating evidence-based metrics in a diverse set of categories for the APPs within our cancer center has started to better illuminate the significance of our contributions. These metrics have now provided the tangible framework necessary for us to demonstrate and improve on the quality of the care we give and to help us grow as
oncology professionals.
