Use of Advanced Practice Providers May Accrue Cost-Savings in Stem-Cell Transplant

VBCC - February 2015, Vol 6, No 1 - Economics of Cancer Care
Wayne Kuznar

San Francisco, CA—A specialized service model that uses nurse practitioners and physician assistants for patients undergoing allogeneic stem-cell transplant (ASCT) may have cost benefits over house staff–based ASCT as a result of the decreased utilization of medical resources, according to researchers at Abramson Cancer Center of the University of Pennsylvania, Philadelphia, at the 2014 American Society of Hematology annual meeting.

A retrospective analysis showed no detriment in clinical outcomes, and perhaps some benefit, to an advanced practice provider model for administering ASCT.

“A specialized inpatient advanced provider practice allogeneic transplant service may decrease the length of stay and result in fewer ICU [intensive care unit] transfers and fewer in-hospital deaths,” said lead investigator Nirav N. Shah, MD, Fellow, Division of Hematology/Oncology, Abramson Cancer Center. “There were potential cost-saving benefits due to the decreased utilization of laboratory and radiologic testing.”

Traditionally, most ASCTs occur at tertiary academic centers where the house staff (ie, medical residents) provides daily care. “With new limitations on resident work hours, alternative models of team-based care replacing residents with advanced practice providers [nurse practitioners and physician assistants] have been used,” he said.

Dr Shah and colleagues compared outcomes from a house staff–based ASCT service in use at the University of Pennsylvania before July 2012 with outcomes from an advanced practice provider–based service that was instituted July 2012.

In the house staff service model, a 24-hour house staff provided care, and residents and a hematologic malignancy attending physician rotated on service every 2 weeks. The advanced practice provider service was staffed by nurse practitioners and physician assistants (Monday–Friday coverage), overnight moonlighters provided weekend and night coverage, and a hematologic malignancy attending physician rotated every 2 weeks.

The evaluation included 86 patients admitted to the house staff service from May 2011 to May 2012, and 81 patients admitted to the advanced practice provider service from October 2012 to October 2013.

The primary analysis compared patient, provider, and cost outcomes before and after the advanced practice provider service was instituted. Patient outcomes included 100-day relapse-free survival and overall survival, length of stay, 14-day and 30-day readmission rates, in-­hospital death rate, ICU transfers, and infectious complications (ie, pneumonia, urinary tract infections, bacteremia, and Clostridium difficile colitis).

The rate of pneumonia was significantly less in the advanced practice provider service group than in the house staff group (15% vs 28%, respectively); other infectious complications were similar in both groups.

Although not statistically significant, there were fewer in-hospital deaths in the advanced practice provider service model versus the house staff model (4% vs 10%, respectively), a decrease in ICU transfers (8.6% vs 18.6%, respectively), and a 3-day shorter mean length of stay. There were no differences in 14-day or 30-day readmission rates. The 100-day survival rates and relapse-free survival rates were similar in the 2 groups, with less relapse in the advanced practice provider group, which did not achieve significance.

Hospital charges and total costs of the hospitalization were not significantly different between the 2 models, although the number of radiologic films ordered ­­(5 vs 8, respectively) and the number of blood cultures ordered (4 vs 7, respectively) were significantly less in the advanced practice provider model.

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Last modified: February 19, 2015
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