Enhancing Follow Up Capacity and Quality at a High-Volume Academic Satellite Practice Through Integration of an Advanced Practice Provider

Abstract

Routine follow-up appointments have been limited at one of our academic facility's satellite clinics due to physician staffing limitations and high consultation volumes. We hypothesized adding an advanced practice provider (APP) on a limited schedule would permit meaningful follow up visits and improve care, while maintaining or increasing patient satisfaction.Beginning in June 2020, an APP was embedded in our academic center satellite clinic one half-day per week to provide routine follow up care after radiation therapy (RT). Patients were provided an anonymized, voluntary satisfaction survey after each initial APP visit from June 2020-Jan 2021. Demographic information and unmet care needs at time of follow up visit were recorded. We compared characteristics of patients seen in the same clinic from June 2019-Jan 2020 and of those seen from June 2020-Jan 2021, prior to APP integration. All patients who completed definitive RT from March 2019-Oct 2019 and from March 2020-Oct 2020 were included for follow up rate comparison.In one half-day of clinic per week, an APP staffed 27.2% (44/118) of all follow up visits at the satellite clinic from June 2020-January 2021, compared to 5.2% of all follow ups seen by an APP from June 2019-Jan 2020. Over comparable timeframes, overall follow up > 90 days from definitive RT completion increased from 33.1% to 46.6% after APP addition. The greatest gains were in patients with cancers of the breast (from 28.6% to 45.7%), prostate (from 37.0% to 47.8%), head and neck (from 68.8% to 88.9%), and lung (from 15.4% to 28.6%). 20.5% of visits with the APP versus 0% with a physician incorporated formalized survivorship care. The APP saw a higher proportion of patients with female gender (64.1 vs 50.5%), age < 65 (59.0% vs 46.4%), and higher estimated median income (EMI) (83.4% vs 76.3%, EMI > $50,000). Importantly, the APP identified and addressed an average of 2.3 unmet care needs per patient at time of follow up, which notably resulted in a new diagnosis of early-stage lung cancer in one patient. Patient satisfaction with APP-based follow up was > 95%, with 95% of patients surveyed indicating they were likely to continue follow up in the clinic.Utilizing an APP at a high-volume radiation oncology satellite clinic improved follow up care by addressing unmet care needs and incorporating survivorship care. Follow up with the APP resulted in high patient satisfaction. These findings emphasize the unique value of radiation oncology-specific follow up, even among those receiving follow up with other oncology sub-specialists, and have important implications for increasing quality of care in high-volume satellite clinics. Based on this interim analysis, APP staffing will be increased to one full day per week to further increase follow up capacity. Data collection is ongoing with final analysis to be completed by July 2021.