Paydarfar Joseph A, Gosselin Benoit J, Tietz Annette M
Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Norris Cotton Cancer Center, Lebanon, New Hampshire, USA.
Otolaryngol Head Neck Surg. 2016 Nov;155(5):723-728. doi: 10.1177/0194599816647945. Epub 2016 May 17.
The urgent nature of head and neck cancer referrals often results in overbooked schedules, access delays, and patient, physician, and staff dissatisfaction. The goal of this study is to examine how incorporation of associate providers (APs) into a head and neck tumor clinic (HNTC) can improve access.
Scheduling data for the Dartmouth-Hitchcock HNTC 2 years prior (January 2011 to December 2012) and 2 years subsequent (January 2013 to December 2014) to program initiation were abstracted, including number of new patients seen per month, third available for new and established patients, overbooked hours, surgeon productivity, and patient satisfaction scores.
New patients seen per month increased from 44 ± 4 to 60 ± 5 (P < .001). Third available for new patients decreased from 56 ± 4 to 27 ± 2 days and from 43 ± 3 to 35 ± 2 days for follow-ups (P < .001). Overbooked hours decreased from 14.7 ± 3.1 to 8.6 ± 1.7 hours (P < .001). Surgeon productivity remained stable (109% ± 11% vs 113% ± 6%, P = .56). Patient satisfaction in seeing APs versus surgeons was comparable (94 ± 2 vs 94 ± 3, P = .79).
Incorporation of APs into the HNTC increases the number of new patients seen by the surgeon, decreases wait times for all appointments, and decreases overbooking while maintaining patient satisfaction and surgeon productivity.
AP incorporation significantly improves access to head and neck surgical services. With improved access, new cancer patients could start treatment sooner, potentially affecting outcome.
头颈部癌症转诊的紧迫性常常导致日程安排过度、就诊延迟以及患者、医生和工作人员的不满。本研究的目的是探讨将助理医疗人员（APs）纳入头颈部肿瘤诊所（HNTC）如何改善就诊机会。
提取了达特茅斯-希区柯克医疗中心头颈部肿瘤诊所项目启动前两年（2011年1月至2012年12月）和后两年（2013年1月至2014年12月）的排班数据，包括每月新患者就诊数量、新患者和复诊患者的第三次可就诊时间、预约超额时间、外科医生工作效率以及患者满意度评分。
每月新患者就诊数量从44±4增加至60±5（P<.001）。新患者的第三次可就诊时间从56±4天降至27±2天，复诊患者的该时间从43±3天降至35±2天（P<.001）。预约超额时间从14.7±3.1小时降至8.6±1.7小时（P<.001）。外科医生工作效率保持稳定（109%±11%对113%±6%，P =.56）。患者对助理医疗人员与外科医生就诊的满意度相当（94±2对94±3，P =.79）。
将助理医疗人员纳入头颈部肿瘤诊所可增加外科医生诊治的新患者数量，减少所有预约的等待时间，并减少预约超额情况，同时保持患者满意度和外科医生工作效率。
纳入助理医疗人员显著改善了头颈部外科服务的就诊机会。随着就诊机会的改善，新癌症患者可更早开始治疗，这可能会影响治疗结果。
