Variation in Scope of Practice of Advanced Practice Providers (APPs) Involved in Care of BMT/HCST Patients

Abstract

The purpose of this study was to describe involvement of APPs in the care of BMT/HSCT patient during treatment. While roles of APPs in caring for BMT/HSCT patients may vary related to geopolitical regulations in scope of practice or institutional approval of privileges, APPs make a significant contribution to the care of BMT/HSCT patients. Methods This was a retrospective cohort study. The study cohort included all patients having BMT or HSCT at hospitals participating in Vizient's Clinical Database/Resource Manager (CDB/RM™) whose encounters occurred between 2014q4 and 2018q3. Analysis included reviewing APP roles, patient demographics, and encounter characteristics. Results Of 63,447 BMT/HSCT encounters in the study period, there were 44 hospitals (of 143 providing BMT/HSCT care) that had 4,472 encounters which had 10,677 instances of 2,902 APPs associated with their care. Six of the 44 hospitals associated more than 10 APPs with their BMT/HSCT patients, thirteen between 2 and 10 APPs, and 25 with 2 or fewer APPs. APPs worked with patients with similar demographic and admission characteristics (although they were involved in the care of fewer elective and more Hispanic patients) and similar discharge characteristics (although they were involved in the care of more patients that died in hospital and had higher (major or extreme) discharge severity of illness. APP LOS averaged 27.8 days (23 days median) while all others averaged 23.5 days (21 days median); APP ICU days averaged 2.1 (0 days median) and all others averaged 4.1 (0 days median); average total direct cost for cases that included APP care was $81,082 ($56,423 median) while all others averaged $67,397 ($47,465 median). Conclusions There are subtle differences in patient and encounter characteristics for BMT/HSCT patients whose management involved APPs. The differences in outcomes need to be addressed by conducting multivariate analysis on the impact of patient and encounter characteristics.