Nonphysician Providers Research Articles

The Global Anesthesia Workforce Survey: Updates and Trends in the Anesthesia Workforce.

There is a large global deficit of anesthesia providers. In 2016, the World Federation of Societies of Anaesthesiologists (WFSA) conducted a survey to count the number of anesthesia providers worldwide. Much work has taken place since then to strengthen the anesthesia health workforce. This study updates the global count of anesthesia providers. Between 2021 and 2023, an electronic survey was sent to national professional societies of physician anesthesia providers (PAPs), nurse anesthetists, and other nonphysician anesthesia providers (NPAPs). Data included number of providers and trainees, proportion of females, and limited intensive care unit (ICU) capacity data. Descriptive statistics were calculated by country, World Bank income group, and World Health Organization (WHO) region. Provider density is reported as the number of providers per 100,000 population. Responses were obtained for 172 of 193 United Nations (UN) member countries. The global provider density was 8.8 (PAP 6.6 NPAP 2.3). Seventy-six countries had a PAP density <5, whereas 66 countries had a total provider density <5. PAP density increased everywhere except for high- and low-income countries and the African region. The overall size of the global anesthesia workforce has increased over time, although some countries have experienced a decrease. Population growth and differences in which provider types that are counted can have an important impact on provider density. More work is needed to define appropriate metrics for measuring changes in density, to describe anesthesia cadres, and to improve workforce data collection processes. Effort to scale up anesthesia provider training must urgently continue.

Sprint-inspired One-on-One Post-Go-Live Training Session (Mini-Sprint) Improves Provider Electronic Health Record Efficiency and Satisfaction.

Inefficient electronic health record (EHR) usage increases the documentation burden on physicians and other providers, which increases cognitive load and contributes to provider burnout. Studies show that EHR efficiency sessions, optimization sprints, reduce burnout using a resource-intense five-person team. We implemented sprint-inspired one-on-one post-go-live efficiency training sessions (mini-sprints) as a more economical training option directed at providers. We evaluated a post-go-live mini-sprint intervention to assess provider satisfaction and efficiency. NorthShore University HealthSystem implemented one-on-one provider-to-provider mini-sprint sessions to optimize provider workflow within the EHR platform. The physician informaticist completed a 9-point checklist of efficiency tips with physician trainees covering schedule organization, chart review, speed buttons, billing, note personalization/optimization, preference lists, quick actions, and quick tips. We collected postsession survey data assessing for net promoter score (NPS) and open-ended feedback. We conducted financial analysis of pre- and post-mini-sprint efficiency levels and financial data. Seventy-six sessions were conducted with 32 primary care physicians, 28 specialty physicians, and 16 nonphysician providers within primary care and other areas. Thirty-seven physicians completed the postsession survey. The average NPS for the completed mini-sprint sessions was 97. The proficiency score had a median of 6.12 (Interquartile range (IQR): 4.71-7.64) before training, and a median of 7.10 (IQR: 6.25-8.49) after training. Financial data analysis indicates that higher level billing codes were used at a greater frequency post-mini-sprint. The revenue increase 12 months post-mini-sprint was $213,234, leading to a return of $75,559.50 for 40 providers, or $1,888.98 per provider in a 12-month period. Our data show that mini-sprint sessions were effective in optimizing efficiency within the EHR platform. Financial analysis demonstrates that this type of training program is sustainable and pays for itself. There was high satisfaction with the mini-sprint training modality, and feedback indicated an interest in further mini-sprint training sessions for physicians and nonphysician staff.

An Investigation of Teledermatology Trends in the State of Texas: A Multicenter, Retrospective Cohort Review of an eConsult Service Line.

Background: An eConsult is a growing teledermatology tool that has the potential to address health disparities. Trends in teledermatology usage are still being defined in the context of the pandemic, postpandemic recovery, and a growing nonphysician primary care provider population. Objective: The aim was to understand teledermatology utilization trends for asynchronous dermatology eConsults in the geographically expansive state of Texas. Methods: This multicenter retrospective study examined the eConsult tool within a large, nonprofit health system, comparing characteristics of 893 eConsult visits with 27,189 in-person dermatology encounters from January 2022 to March 2023. Results: When comparing the demographics of patients seen through eConsult versus traditional in-person visits, eConsults demonstrated a significantly higher prevalence of pediatric (22.5% vs. 7.6%, p < 0.001), Hispanic/Latino (20.5% vs. 10.4%, p < 0.001), African American (12.5% vs. 6.9%, p < 0.001), Asian (4.6% vs. 2.1%, p < 0.001), and American Indian (1.0% vs. 0.5%, p = 0.049) patients compared with in-person visits. eConsult users came from areas with a lower percentage of bachelor's degree holders, reduced average household income, and an increased proportion of Medicaid and Tricare users. Physicians (MD/DO) submitted more eConsult cases than nonphysician providers (NPPs), with comparable diagnostic agreement with teledermatologists and similar recommendation rates for in-person dermatology visits. Conclusions: While the limitation of this study was that it was a descriptive data analysis in a single health care system with limited generalizability, eConsults hold promise to broaden dermatologic access for underserved groups, especially children, individuals from underrepresented backgrounds, and Medicaid and Tricare members. While no significant diagnostic or referral differences were seen for eConsults initiated by primary care physician and NPPs, these changing trends should continue to be examined.

Global pediatric anesthesia-Anglophone West Africa perspective.

This article gives the pediatric anesthesia perspective from Cameroon, Nigeria, Ghana, Liberia, and Gambia, five out of six countries in Anglophone West Africa. Over 40% of the population of most of these countries are younger than 14 years and there is an increasing need for paediatric anesthesia services. Workforce density ranges from 0.08 to 0.58 physician anesthesia providers per 100,000 population. There are only 13 trained pediatric anesthetists; ratios range from 0 to 0.4 per 100,000 children, thus pediatric anesthesia services are provided by various cadres of physician and non-physician anesthesia providers. Physician anesthesia training is mostly carried out by the West African College of Surgeons as well as national postgraduate colleges. Pediatric anesthesia services are provided in tertiary (teaching), secondary (general), district, faith-based, military, private hospitals and through surgical missions. Challenges include lack of trained personnel, high morbidity from late presentation to health facilities and financial constraints, lack of health insurance for pediatric anesthesia services, unavailability of appropriate equipment and consumables, a narrow range of medications, very few pediatric-specific operating theaters, and inadequate critical care services. The lack of opportunities for sub-specialty training in pediatric anesthesia in West Africa is currently being addressed in Nigeria and Ghana. Non-governmental agencies fund programs and courses related to pediatric anesthesia and have also provided fully equipped operating theaters. Advocacy for pediatric anesthesia can be achieved through the National Surgical Obstetric Anesthesia and Nursing Plans Implementation Committee of the various countries. There is an urgent need for prioritization of health in the budgets of Anglophone West African countries and governments must deliberately provide support for anesthesia and surgical services. More international collaborations towards workforce training and creation of children's hospitals are needed.

Improving the Capacity of Non-Physician Primary Care Providers to Address Child and Youth Mental Health Through Mental Health Literacy Approaches.

Canadians rely on their primary care providers to address their mental health needs, but there are longstanding system gaps that must be addressed to enhance their ability to deliver mental health care. The present study addressed the gap in pediatric mental health care through the development, delivery, and evaluation of a mental health literacy training among non-physician primary care providers. We delivered the training among 97 participants, with all completed the pre-test survey, and 74 completed the post-test survey on knowledge, attitudes toward mental health, and help-seeking intentions. Additionally, participants explained why they attended the training and shared how they would apply the knowledge learned into their practice (behaviors). Participants improved their knowledge significantly from pre-test to post-test, P < .001, d = 2.51. We didn't find any statistical significance between pre-test and post-test on attitudes, P = .067, nor on help-seeking intentions, P = .274. However, participants' scores were exceedingly high on both outcomes, indicating positive attitudes and intentions at 2 time points and implying a ceiling effect of both outcomes. We did not find outcome differences by demographics, practice year, practice zone, or professional role. While knowledge, years of practice and prior mental health training predicted participants attitudes at pre-test, they didn't at post-test. Attitudes toward mental health predicted help-seeking intentions. Participants indicated this training will change their practice behaviors. This mental health literacy training for primary care providers demonstrated strong evidence of the need to integrate mental health and addiction support into primary care practice.

Association between emergency department computed tomography utilization rate and patient satisfaction: A clinician level analysis across a regional healthcare system

BackgroundComputed Tomography (CT) use is common during emergency department (ED) visits, and ED clinicians may order CTs for myriad reasons, including desire to improve patient satisfaction. ObjectivesTo determine if greater CT use by ED clinicians is associated with increased average patient satisfaction scores for those providers. MethodsThe study took part across 15 non-pediatric hospitals in a regional healthcare system. We compared clinician CT use rate for adult patients discharged from the ED with Net Promotor Score (NPS) for that clinician. NPS is a patient satisfaction metric with a possible range of scores from −100 to +100. We included ED clinicians (physicians and non-physician providers (NPPs)) with at least 500 adult patient encounters resulting in ED discharge from July 2020 through June 2022. We assessed for an association between CT use and clinician NPS using univariate and multivariate regression models. ResultsAcross the 15 hospitals, 166 physicians and 74 NPPs were included in the study. The median CT rate was 25.7 ​% (range 7.1 ​%–48.9 ​%). In both models, there was a statistical association between CT utilization and NPS such that every absolute increase in CT use by 10 ​% resulted in a 3-point improvement in provider NPS on the 200-point scale. When examined in a sensitivity analysis, none of the hospitals individually showed this same association. ConclusionsWe found a 26 ​% rate of CT use by clinicians for adults discharged from the ED, with wide variation in utilization between clinicians. There was a small and inconsistent association between CT utilization and clinician specific NPS scores.

Who Posts on Instagram? Using Natural Language Processing to Assess the Relationship Between Training Background and Content of 700,000 Posts.

Instagram (Menlo Park, CA) is a major platform for the dissemination of plastic surgery (PS) information, but the training background of users is difficult to ascertain. We sought to better characterize the source and content of PS-related posts on Instagram. Metadata from publicly available Instagram posts containing PS relevant hashtags was collected from December 2018 to August 2020 using Node.js (Node.js Foundation, San Francisco, CA). The data was characterized by account type, and post topics were analyzed using a custom dictionary of PS procedures applied with natural language processing. All data analyses were performed with R (The R Foundation, Vienna, Austria). Board-certified plastic surgeons account for 38% of posts on Instagram, followed by organizations (31%), nonplastics-trained physicians (19%), facial plastics (5%), oculoplastics (1%), and nonphysician providers (5%). Oculoplastics had the highest engagement rate with their posts (3.7 ± 5.1), whereas plastic surgeons had the lowest (2.7 ± 4.2). Breast aesthetics was the predominant topic posted by plastic surgeons (42%, P < .001), and board certification phrases distinguished their posts from other account types (23%, P < .001). Nonphysician posts focused on nonsurgical aesthetics like Botox and fillers (80%). However, nonplastics-trained physicians and organizations significantly contributed to procedural subcategories in a similar distribution to plastic surgeons. Board-certified plastic surgeons are not the predominant source of PS content on Instagram. Furthermore, posts by plastic surgeons have the lowest rate of engagement out of all account types studied. Although declarations of board certification distinguish content from plastics disciplines, they are only used in 21% of posts.

Moving to the Middle Ground: Redefining Genomic Utility to Expand Understanding of Familial Benefit.

Translational research has tended to ignore the question of whether receiving a genomic diagnosis provides utility in community care contexts outside of doctors' offices and hospitals. However, empirical research with parents has highlighted numerous ways that a genomic diagnosis might be of practical value in the care provided by teachers, physical or occupational therapists, speech-language pathologists, behavior analysts, and nonphysician mental health providers. In this essay, we propose a new conceptual model of genomic utility that offers the opportunity to better capture a broad range of potential implications of genomic technologies for families in various social and organizational systems. We explore crucial research directions to better understand how redefined utility might affect families and nonphysician professionals.

Psychometric properties of the Persian version of Conners Early Childhood ADHD Questionnaire-Parents’ Form in Iranian children aged 3-6 years

Background. Attention deficient-hyperactivity disorder (ADHD) is the most prevalent psychiatric diagnosis in preschool children. The present study aimed to translate and determine the validity and reliability of the Persian version of Conners Early Childhood Attention Deficit-Hyperactivity Disorder Questionnaire–Parents’ Form in Iranian children aged 3-6 years. Methods. We included 1,013 pediatrics aged &lt;6 years in 2017-18 in Tabriz, Iran. In the first step, the questionnaire was translated into Persian using the re-translation method. Then, the content validity of the questionnaire was evaluated by ten specialists. Finally, the concurrent validity of the questionnaire was simultaneously compared with the children’s Strengths and Difficulties Questionnaire (SDQ). ROC curve was used to determine the best cut-off point, and sensitivity and specificity were measured to determine the questionnaire’s diagnostic value compared to the clinical psychiatric interview. The test-retest method was used to determine reproducibility using the intra-class correlation coefficient (ICC). The internal consistency was also evaluated with Cronbach’s alpha test. Results. Of all the 1,013 participants, 569 (56.2%) were female. The overall modified kappa agreement and concurrent validity coefficients were 0.76 and 0.70, respectively. The sensitivity and specificity of the questionnaire was estimated 86.8% and 79.4%, respectively. The ICC was calculated at 0.90, and the questionnaire’s internal consistency was calculated at an overall Cronbach’s alpha coefficient of 0.88. Conclusion. The Persian version of Conners Early Childhood Attention Deficit-Hyperactivity Disorder Questionnaire–Parents’ Form exhibited proper reliability and validity for screening the Iranian pediatric population. Practical Implications. The emerged validated tool from the present study can be used in the first-line health system in the public and private sectors for physician and non-physician healthcare providers, especially family physicians in primary health care.

Comparing characteristics and perspectives of U.S. anesthesiology fellows in training and anesthesiologists in their first year of practice

BackgroundThe purpose of this study was to evaluate relationships between demographics, professional characteristics, and perceived challenges facing the specialty of anesthesiology among physicians who entered a fellowship and those who started independent practice immediately after finishing a U.S. anesthesiology residency.MethodsAnesthesiologists in the year after their residency graduation were invited to take an online survey during the academic years of 2016–2017, 2017–2018, and 2018–2019, with questions about their personal characteristics, the nature of their professional lives, and their perceptions of the greatest challenge facing the profession of anesthesiology.ResultsA total of 884 fellows-in-training and 735 anesthesiologists starting independent practice right after the completion of their residency responded. Fellows were slightly younger (mean = 33.2 vs. 34.0 years old, p < 0.001), were more likely to have a spouse who works outside the home (63.9% vs. 57.0%, p = 0.002), had fewer children (mean = 0.69 vs. 0.88, p < 0.001), worked more hours per week (mean = 56.2 vs. 52.4, p < 0.001), and were less likely to report a personal and professional life balance (66.4% vs. 72.3% positive, p = 0.005) than direct-entry anesthesiologists. Fellows and direct-entry anesthesiologists identified similar challenges in three broad themes – workforce competition (80.3% and 71.8%), healthcare system changes (30.0% and 37.9%), and personal challenges (6.4% and 8.8%). Employment security issues posed by non-physician anesthesia providers and perceived lack of appreciation of anesthesiologists’ value were commonly cited. Relative weighting of challenge concerns varied between fellows and direct-entry physicians, as well as within these groups based on gender, fellowship subspecialty, location or size of practice, and frequency of supervisory roles.ConclusionsAnesthesiology fellows and direct-entry anesthesiologists had largely similar demographics and perspectives on the challenges facing anesthesiology in the United States. Group differences found in some demographics and perspectives may reflect different motivations for choosing their professional paths and their diverse professional experiences.

Prevalence and Predictors of Multimodal Treatment Among U.S. Adults Newly Diagnosed With ADHD

Although a combined treatment of prescription medication and psychotherapy provides long-term benefits for adults with attention deficit/hyperactivity disorder (ADHD), little is known about the prevalence of receiving such multimodal treatment. This study investigated trends in the prevalence and correlates of multimodal treatment among U.S.-insured adults newly diagnosed with ADHD. 495,180 U.S. adults from the Komodo Healthcare Map with newly diagnosed ADHD in 2017-2021 were included. Descriptive statistics were used to estimate trends in the prevalence of treatment (no treatment, prescription-only, psychotherapy-only, or both) within 3 months from the index ADHD diagnosis. Multinomial logistic regression was used to examine patient and provider characteristics associated with ADHD treatment. Analysis was conducted in May 2023. From 2017 to 2021, the prevalence of newly diagnosed ADHD adults receiving multimodal, prescription-only, and psychotherapy-only treatment within 3 months following their first diagnosis increased from 12.9% to 21.4%, 30.2% to 33.3%, and 18.4% to 20.4%, respectively. Over the same period, the prevalence of newly diagnosed ADHD adults receiving no treatment declined from 38.5% to 25%. Relative to their counterparts, the odds of receiving multimodal ADHD treatment were significantly lower (p<0.05) for men, older adults, adults with multiple co-existing conditions, Medicaid and Medicare beneficiaries, and those living in socially disadvantaged areas. Furthermore, the odds of receiving multimodal treatment were higher (p<0.05) for adults who saw a nurse practitioner, physician assistant, or behavioral care (non-physician) provider on their first visit with an ADHD diagnosis, compared to those who saw a physician. 25% of newly diagnosed ADHD adults received no treatment in 2021 and 53.7% only received a single-modality treatment-raising concerns about the potential implications of untreated ADHD or insufficient treatment on the persistence of ADHD-related impairments, morbidity, productivity, and downstream healthcare cost. The study also highlighted potential sociodemographic, clinical, and provider disparities in ADHD treatment.

Children's Anaesthesia and perioperative care challenges, and innovations

The 2015 Sustainable Development Goals emphasise good health to all with reduced inequalities, and surgical and anaesthesia care is essential to achieve these. https://sdgs.un.org/goals. However, it has been estimated that 1.7 billion children do not have access to safe anaesthesia and surgery when needed and this disproportionately affects children in low- and middle-income countries (1). It is alarming that 1 in 10 individuals in LMICs do not have access to safe surgical care. Both safe surgery and anaesthesia are essential for ensuring that individuals receive proper medical attention. Economically viable public health initiatives that can avert many disability-adjusted years are needed. (2–4)Morbidity and mortality from surgical disease and anaesthesia care remain high in low-income countries, unlike in high-income countries. The incidence of severe anaesthesia-related critical events and perioperative cardiac arrest is between three and ten times more in LMICs than in HICs (5–7) A baseline POMR that is 100 times higher in LMICs compared to HICs is reported. (8) This perioperative morbidity and mortality gap is more evident in neonates and younger age groups, especially in children with congenital abnormalities. The challenges facing providers of anaesthesia and perioperative care are multifactorial and include but are not limited to the inadequate workforce, inadequate and inappropriate infrastructure, lack of adequate and appropriately sized equipment, including monitors, and safe monitoring capacity, supply chain challenges for medicines and reusable consumables, unreliable supply of oxygen and blood products, lack of data and research for policy formulation, inadequate resource allocation from governments and lack of safety culture among other things. In paediatrics, this is further multiplied by the variability in the sizes of the patients, from neonates to older children (9).1.Improved perioperative care must include anaesthesia and nursing to improve perioperative outcomes for children.2.Perioperative care for children in LMICs is predominantly by non-physician anaesthesia providers or non-specialty-trained anaesthesiologists.3.There is a need to train physician anaesthesia leaders to direct and oversee the care of children undergoing anaesthesia4.Infrastructure and equipment for the safe provision of paediatric anaesthesia/perioperative care are usually wanting/often times inadequate and inappropriate.5.The GICS OReCS document provides a valuable guide for the bare minimum requirements for the provision of safe paediatric anaesthetic and surgical care services, starting at the district hospital.6.Equipment donations should be conscientious, in consultation with local leads. Considerations will include biomedical support for maintenance, availability of spare parts, and electrical compatibility, among others.7.Context-specific innovations have been shown to work in LMICs and include paediatric anaesthesia courses for all providers and simulation-based training using low technology.8.Any worthwhile programs aimed at improving anaesthetic and surgical care for children need to ultimately fit into national healthcare systems.

The Differences in the Practice of Cosmetic Dermatologic Procedures Between Physicians and Nonphysicians.

With a rise in demand for cosmetic dermatologic procedures comes an increase in nonphysician providers performing such procedures. However, little is known about the practice of cosmetic procedures performed by nonphysicians. To assess the differences in the practice of cosmetic procedures provided by physicians and nonphysicians. A cross-sectional analysis was performed using participant ( n = 4,062) responses to an 18-point, web-based survey about previous cosmetic procedures. In total, 1,328 participants reported having previous cosmetic procedures done by a physician ( n = 828), a nonphysician ( n = 413), or an unknown provider ( n = 87). Respondents of all age ranges and male respondents ( p < .001) tended to choose physicians over nonphysician providers when choosing a practice. Moderate adverse events were more frequently seen when nonphysician providers completed cosmetic procedures ( p < .001). Despite a higher frequency (73.3% vs 51.8%) of more moderate complications seen in procedures done by nonphysician providers, over 70% of respondents believe that nonphysician providers are qualified enough to continue performing cosmetic procedures. People should be encouraged to make an informed decision when choosing a provider because cosmetic procedures are still considered medical procedures.

Evaluation of satisfaction with and relief vs. workload by ageneral practitioner-centered dementia care project: early information and support in dementia (FIDEM) in Göttingen, Germany

Early information and support in dementia (FIDEM) is across-sectoral, general practitioner-centered network model for the improvement of community-based care of people with dementia and their caregivers by systematically assigning them to non-physician healthcare providers. To describe the implementation of FIDEM in Göttingen, Germany and to exploratorily evaluate satisfaction and relief vs. additional workload. FIDEM was established in Göttingen in 2017. Community-based and district-based networks consisted of medical (general practitioners) and non-medical cooperation partners (occupational therapists, care counselling, other non-medical care providers) and were instructed to efficiently share information. During biannual network meetings from August 2017 to October 2019, aself-developed questionnaire for quality management and evaluation of the aspects of the project described above was filled out by participants attending the meetings. Consecutive recruitment resulted in 7 networks by October 2019, with participation of 29 general practitioners and 46 non-medical care providers, serving as cooperation partners. Quantitative evaluation of 80 FIDEM cooperation partners revealed high satisfaction ratings with all aspects of the model (Mfrom 7.22 to 7.87 out of possible "10"), with partially higher ratings on the part of primary care physicians. Furthermore, all participants reported areduction in workload due to participation, which was significantly higher for primary care physicians across all scales (all p-values < 0.001). FIDEM has been implemented in Göttingen beyond afunded pilot project phase. High satisfaction ratings and considerable relief in workload suggest the continuation of FIDEM along with afull evaluation and, provided positive results, its consolidation of and transfer to other regions in Germany.

Obstetric anaesthesiology: manpower and service provision issues in India

Obstetric anaesthesiologists play a pivotal role as peripartum physicians steering the team of obstetric healthcare providers towards a continuum of medical education, enhanced training and safer patient care. However, in resource-limited countries, deficiency of human resources and hence services available poses challenges to those attempting to reduce maternal mortality rates. Measures to fill the gap include creating a cadre of uniformly well-trained and certified non-physician anaesthesia providers (NPAPs) supervised by a physician obstetric anaesthesiologist and well-equipped rural and urban health care facilities. The Association of Obstetric Anaesthesiologists of India needs to upscale their outreach programs with regular knowledge updates and practical skill training to the NPAPs, medical graduates and postgraduate doctors in these regions. A combination of strong local administrative will, legislation for the provision of essential supplies and a global collaborative effort using checklists and protocols may help to stem gaps in the provision of safe maternal care.

Health outcomes and provider choice under full practice authority for certified nurse-midwives

Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008–2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.

Defining Priorities in Value-Based Cancer Care: Insights From the Alliance for Clinical Trials in Oncology National Cooperative Group Survey.

We determine how stakeholders prioritize the importance of oncologic outcomes, patient-reported outcomes (PROs), and cancer-related health care costs. A survey was distributed to the National Clinical Trials Network Alliance for Clinical Trials in Oncology cooperative group membership from May 14 to June 30, 2022. Respondents were asked to rate (5-point Likert scale) and rank (1-9) evidence-based value domains: overall survival, treatment toxicities/complications, quality of life (QOL), financial toxicity, access to care, compliance with evidence-based care, health system performance, scientific discovery and innovation, and cost to the health care system. A total of 514 members responded, including researchers (24.7%), nurses (19.5%), medical oncologists (17.9%), administrators (9.3%), surgical and radiation oncologists (9.1%), patient advocates (3.1%), and nonphysician providers (16.4%). Participants represented various practice settings including National Cancer Institute-designated cancer centers (29.8%), university-affiliated academic cancer centers (21%), hospital-owned oncology practices (21.8%), and others (27.4%). There was agreement in how respondents prioritized value domains (W = 0.39, P < .001). Respondents ranked patient QOL (mean rank: 2.6 ± 1.9) as most important above all other metrics including survival (mean rank: 3.5 ± 0.3) and access to care (mean rank: 3.5 ± 2.1; P < .001). Members engaged in direct patient care also ranked access to care of higher importance than nonclinicians (P = .026). Cost to the health care system (mean rank: 7.5 ± 2.1) and health system performance (mean rank: 7 ± 2) were ranked as least important (P < .001). Inclusion of PROs into therapeutic assessment (59.3%) was the most frequently selected priority of future cooperative group initiatives. Oncology community stakeholders deemed patient-centered value domains as most important and considered patient QOL the highest priority. Inclusion of PROs into clinical trials was endorsed as an important component of therapeutic assessment. These findings can be taken into consideration when creating a value framework for inclusion in cancer clinical trials.

Factors associated with adherence to provider referrals for lung cancer screening with low dose computed tomography before and during COVID-19 pandemic

BackgroundLung cancer has been the leading cause of American deaths from cancer. Although Medicare started covering lung cancer screening (LCS) with low-dose computed tomography (LDCT) in 2015, the uptake of LDCT-LCS remains low. This study examines the changes in adherence to provider referrals for LDCT-LCS and the factors at patient, provider, and health system levels that influence the completion rate of LDCT-LCS orders before and during the COVID-19 pandemic.MethodsOur study examined electronic health record data (December 2013 - December 2020) from a large, community-based clinical healthcare delivery system in California. We plotted monthly trends in the frequency of LDCT-LCS orders and completion rate and compared the annual LDCT-LCS completion rate between LCS-eligible, LCS-ineligible, and unknown eligibility groups. We then explored multilevel factors associated with the completion of LDCT-LCS orders using hierarchical generalized linear models.ResultsThere was an increase in LDCT-LCS orders (N = 12,469) from 2013 to 2019, followed by a sharp decline in March 2020 due to the onset of the COVID-19 pandemic. Thereafter, LDCT-LCS orders slowly increased again in June 2020. The completion rate of LDCT-LCS increased from 0% in December 2013 to approximately 70% in 2018–2019 but declined to 50–60% in 2020 during the pandemic. Ineligible patients had lower completion rates of LDCT-LCS. Patients who were new to the healthcare system, Black, received the LDCT-LCS order in the first few years after Medicare coverage (2016 or 2017), during the pandemic, had major comorbidities, and smoked less than 30 pack-years were less likely to complete an order. Patients were more likely to complete LDCT-LCS orders if they were younger, received the LDCT-LCS order from a physician (vs. nonphysician provider), from family medicine or other specialties (vs. internal medicine), or saw a provider with more experience in LDCT-LCS.ConclusionsThe beginning of the COVID-19 pandemic largely decreased the volume of LDCT-LCS orders, but rates have since been slowing recovering. Future interventions to improve lung cancer screening should consider doing more targeted outreach to new patients and Black patients as well as providing additional education to nonphysician practitioners and those providers with lower rates of LDCT-LCS referral orders.

U.S. Primary Care Provider Needs: An Analysis of Workforce Projections and Policy Implications.

The primary care (PC) physician workforce has consistently been projected as requiring additional numbers to meet the needs of the U.S. The Health Resources and Service Administration (HRSA) has reported the PC nurse practitioner (NP) workforce to be 90,000 NPs more than required to meet the PC needs of the U.S. With both clinician types contributing to the PC workforce in the country, it is difficult to understand such an oversupply of NPs with continued deficit in PC physicians. The purpose of this study was to investigate results and methods used for HRSAs current PC workforce projections and compare those with the same used for Bureau of Labor Statistics (BLS) and American Association of Medical Colleges (AAMC) projections. Methods included a review of technical documents, dashboards, and published reports. Interviews with subject matter experts were also completed. Projections were found to differ significantly, as did data and assumptions. Two of the three projections modeled physicians as the sole provider of PC. An integrated model gives the most comprehensive and accurate picture of PC workforce needs. The utilization of NPs as PC providers has been demonstrated to be safe and effective, with the potential to alleviate predicted shortages, improve patient care outcomes, reduce cost, and address PC inequities. Implications include improving workforce data, creating projections that mirror clinical integration in PC, adjusting workforce preparation funding, incentivizing interprofessional collaboration in research, addressing barriers to practice among non-physician providers, and leveraging growth in the NP workforce.

Patient‐controlled use of nonphysician providers: Appointment scheduling in mixed‐provider settings

The aging population and increasing chronic disease load are rapidly changing the face of primary care delivery, with mid‐level (e.g., nurse) practitioners providing growing proportion of patient care. Potential differences in the quality of care offered by physicians and nurse practitioners may affect patient preferences, thus leading to patient choice behavior. This paper focuses on the problem of appointment scheduling for physician–nurse teams in the presence of patient choice and no‐shows. We propose a novel model that accounts for patient choices in a system with two provider types. Despite the increased structural complexity of the model, we derive sufficient conditions under which the problem is efficiently solvable. To counter the computational challenges arising in the general setting, we propose an easy‐to‐implement heuristic, which is proven to be optimal in the absence of patient no‐shows. Our numerical study shows how the ratio of qualities of care delivered by nurses and physicians affect the profitability of the medical practice, enabling the analysis of the trade‐offs involved in hiring a nurse practitioner. This paper introduces a patient‐controlled approach to incorporating nonphysician providers into physician‐led outpatient care delivery systems and compares it to widely used “ice breaker” and “standalone” modes of using nonphysician providers. Our findings reveal that clinical practices that employ mixed (physicians and nonphysicians) provider pools can significantly improve their financial and operational performance by moving away from the “ice breaker” and “standalone” use of nonphysician providers by delaying the selection of an appropriate care provider till the actual day of care delivery.