Chan Kenny H, Dinwiddie Jordyn K, Ahuja Gurpreet S, Bennett Erica C, Brigger Matthew T, Chi David H, Choo Daniel I, Cunningham Michael J, Elluru Ravindhra G, Giannoni Carla M, Goudy Steven L, Koempel Jeffrey A, MacArthur Carol J, Malone Barbara, Messner Anna H, Mitchell Ron B, Park Albert H, Richter Gresham T, Rosbe Kristina W, Shah Udayan K, Sie Kathy C Y, Smith Richard J, Sulman Cecille G, Thompson Jerome W, Thorne Marc C, Wei Julie L, Wetmore Ralph F, White David R, Zalzal George H, Schoem Scott R
Children's Hospital Colorado, Aurora, CO, USA; Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Children's Hospital Colorado, Aurora, CO, USA; Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Int J Pediatr Otorhinolaryngol. 2020 Feb;129:109770. doi: 10.1016/j.ijporl.2019.109770. Epub 2019 Nov 7.
Advanced practice providers (APPs), including nurse practitioners and physician assistants, have been deployed in children's hospital-based academic pediatric otolaryngology practices for many years. However, this relationship in terms of prevalence, roles, financial consequences and satisfaction has not been examined. The objective of this study is to explore how APPs impact healthcare delivery in this setting.
Pediatric otolaryngology chiefs of all academic children's hospitals in the US were electronically surveyed about the ways APPs intersected clinically and financially in their respective practice.
A total of 29 of 36 children's hospital-based pediatric otolaryngology practices completed the survey, of which 26 practices (90%) utilized APP. There were large variances within the APP practice cohort in faculty size (mean/median/range = 9.4/8.5/3-29); annual patient visits (mean/median = 18,373/17,600); number of practice site (mean/median/range = 4.3/4/2-9) and number of outpatient APP (mean/median/range = 6.3/5/1-30). No factors (faculty size, annual visits and number of practice sites) differentiated between the APP and non-APP practices. Among APP practices, significant correlation (p<.00001) was observed between size of APP cohort to faculty size and annual visits. 69% of the practices did not differentiate job functions of nurse practitioners and physician assistants. 85% of the practices utilized APPs in all practice sites and 19% utilized APPs in the operating room. 77% of APPs billed independently and 46% had on-site supervision. The most prevalent APP salary bracket based on 0-5, 6-10 and > 11 years of tenure were $76-100K (65%), $100-150K (77%) and $100-150K (86%), respectively. In 46% of the practices, APPs were able to generate enough revenue to cover more than 75% of their salary and 23% of practices generated a profit. 81% of the chiefs ranked the effectiveness of APPs as high (4 and 5) on a 5-point Likert scale.
The majority of academic pediatric otolaryngology practices employed APPs. Despite the diversity seen in practice complexity, APP functionality and financial impact, most found the APP model to be beneficial in improving patient care, patient access and faculty productivity.
包括执业护士和医师助理在内的高级实践提供者（APP）已在儿童医院的学术性儿科耳鼻喉科实践中应用多年。然而，这种关系在普及率、角色、财务影响和满意度方面尚未得到研究。本研究的目的是探讨APP在这种环境下如何影响医疗服务的提供。
对美国所有学术性儿童医院的儿科耳鼻喉科主任进行电子调查，了解APP在他们各自实践中的临床和财务交叉方式。
36家儿童医院的儿科耳鼻喉科实践中共有29家完成了调查，其中26家（90%）使用了APP。在APP实践队列中，教员规模（均值/中位数/范围 = 9.4/8.5/3 - 29）、年度患者就诊量（均值/中位数 = 18,373/17,600）、实践地点数量（均值/中位数/范围 = 4.3/4/2 - 9）和门诊APP数量（均值/中位数/范围 = 6.3/5/1 - 30）存在很大差异。没有因素（教员规模、年度就诊量和实践地点数量）能区分使用APP和未使用APP的实践。在使用APP的实践中，观察到APP队列规模与教员规模和年度就诊量之间存在显著相关性（p <.00001）。69%的实践没有区分执业护士和医师助理的工作职责。8
