Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
Breast Cancer Res Treat. 2020 Jan;179(1):57-65. doi: 10.1007/s10549-019-05447-x. Epub 2019 Sep 21.
Advanced practice providers (APPs) have increasingly become members of the oncology care team. Little is known about the scope of care that APPs are performing nationally. We determined the prevalence and extent of APP practice and examined associations between APP care and scope of practice regulations, phase of cancer care, and patient characteristics.
We performed an observational study among women identified from Medicare claims as having had incident breast cancer in 2008 with claims through 2012. Outpatient APP care included at least one APP independently billing for cancer visits/services. APP scope of practice was classified as independent, reduced, or restricted. A logistic regression model with patient-level random effects was estimated to determine the probability of receiving APP care at any point during active treatment or surveillance.
Among 42,550 women, 6583 (15%) received APP care, of whom 83% had APP care during the surveillance phase and 41% during the treatment phase. Among women who received APP care during a given year of surveillance, the overall proportion of APP-billed clinic visits increased with each additional year of surveillance (36% in Year 1 to 61% in Year 4). Logistic regression model results indicate that women were more likely to receive APP care if they were younger, black, healthier, had higher income status, or lived in a rural county or state with independent APP scope of practice.
This study provides important clinical and policy-relevant findings regarding national practice patterns of APP oncology care. Among Medicare beneficiaries with incident breast cancer, 15% received outpatient oncology care that included APPs who were billing; most of this care was during the surveillance phase. Future studies are needed to define the degree of APP oncology practice and training that maximizes patient access and satisfaction while optimizing the efficiency and quality of cancer care.
高级执业护士（APP）已逐渐成为肿瘤治疗团队的一员。目前尚不清楚全国范围内 APP 护理的范围。我们确定了 APP 实践的普遍性和程度，并研究了 APP 护理与实践范围法规、癌症护理阶段以及患者特征之间的关联。
我们对 2008 年至 2012 年期间医疗保险索赔中被确定患有乳腺癌的女性进行了一项观察性研究。门诊 APP 护理包括至少一名 APP 独立为癌症就诊/服务计费。APP 实践范围分为独立、减少或受限。采用患者水平随机效应的逻辑回归模型来确定在积极治疗或监测期间任何时候接受 APP 护理的概率。
在 42550 名女性中，有 6583 名（15%）接受了 APP 护理，其中 83%在监测阶段接受了 APP 护理，41%在治疗阶段接受了 APP 护理。在接受给定年份监测的女性中，每年接受 APP 护理的总比例随监测年限的增加而增加（第 1 年为 36%，第 4 年为 61%）。逻辑回归模型结果表明，如果女性年龄较小、为黑人、身体更健康、收入水平更高，或者居住在具有独立 APP 实践范围的农村县或州，她们更有可能接受 APP 护理。
本研究提供了有关 APP 肿瘤学护理的全国实践模式的重要临床和政策相关发现。在患有乳腺癌的医疗保险受益人中，有 15%接受了包括计费 APP 在内的门诊肿瘤学护理；大多数护理发生在监测阶段。需要进一步研究以确定最大限度地提高患者可及性和满意度，同时优化癌症护理效率和质量的 APP 肿瘤学实践和培训程度。
