Objective Advanced practice providers (APPs) may see patients independently or assist in “collaborative” clinics in otolaryngology practices. Our goal was to redesign the collaborative physician-APP clinic model to increase patient access, maintain financial sustainability, and optimize patient and staff experience. Methods The study was performed in a tertiary care academic rhinology clinic seeing adult patients. The DMAIC framework (define, measure, analyze, improve, control) was used to develop the new model. The process shift between old and new models was analyzed by utilizing a statistical process control chart. Patient and staff surveys were tracked. Results The collaborative physician-APP model was redesigned into 2 parallel and independently run (“concurrent”) physician and APP clinics. Patient access increased by 38.9% from a mean of 17.9 patients per collaborative clinic (n = 15 days, 269 patients) to 29.3 patients per concurrent clinic (n = 12 days, 352 patients). Medicare reimbursement rate modeling showed the collaborative clinic to operate at a loss of $1341.51 per day, while the concurrent clinic model operated at a $1309.88 gain (200% positive change). Patient and staff experience tracked positively. Discussion Otolaryngology clinics can become overwhelmed by the volume of empaneled established patients. Traditional collaborative physician-APP clinics see the same panel of patients together. However, these can be successfully redesigned to a concurrent model. Concurrent clinics improve patient access and provider satisfaction while maintaining patient satisfaction and fiscal performance. Implications for Practice Leveraging an experienced APP to run a parallel and independent clinic alongside the physician (concurrent clinic model) may improve patient access, financial metrics, and patient/staff experience.

Background:The study objective was to investigate the willingness to pay (WTP) for teledermoscopy services among students at a university health center. The hypothesis was that WTP for teledermoscopy among students would exceed the costs for traditional consultation.Methods:Between November 2013 and May 2014, students at a university health center were surveyed for their perceptions of teledermoscopy. One set of responses was collected from students visiting the health center for any reason (anonymous sample). An additional set of responses was collected from students visiting for dermatologic lesions (in-person sample). A contingent valuation method with a maximum likelihood estimation procedure was used to estimate the WTP distribution.Results:A total of 214 surveys were collected for the anonymous sample and 41 responses for the in-person sample. The mean (standard deviation [SD]) WTP for the anonymous sample was $55.27 ($39.11; 95% confidence interval [CI]: $49.99-$60.55). The mean (SD) WTP for the in-person sample was $52.37 ($26.56; 95% CI: $43.99-$60.75). Median WTP for the 2 samples was similar: $48.84 and $48.01.Conclusions:We conclude that students would be willing to pay for teledermoscopy services that would provide the potential for significant system cost savings. This may be especially true in college health or similar settings where dermatology services may not be available.

Introduction: Congenital Heart Disease (CHD) is a problem with structure and function of the heart that is present at birth.  Children with CHD require special care, treatment and follow up for a number of common conditions which may be quite straining to the care givers. The objective of the study was to find out the burden of care among mothers having children with CHD. Methods: This descriptive cross-sectional study was carried out in a cardiac centre of Nepal. A total of 95 mothers having children with CHD attending outpatient department of our institute were selected as the sample for the study using non-probability purposive sampling technique. A semi structured interview questionnaire consisting of the Modified Caregiver Strain Index was used to assess the burden of care among mothers having children with CHD. Frequency and percent were used to describe the variables and chi- square test at 0.05 significance level was used to analyse associations. Results: Most (77.9%) of the mothers were regularly strained to find that their children’s health condition was deteriorating due to CHD. Nearly half (44.2%) of the mothers always had financial constrain while giving care to the child, nearly half (40%) of the mothers had done emotional adjustments to take care of their children with CHD, another two-fifths (28.4%) of the mothers sometimes had disturbed sleep and almost half (46.3%) of the mothers were always upset due to some behaviour of their child with CHD. Half (50.5%) of the mothers had high level of burden of care. Statistically significant association were found between age of the mother and level of burden of care (p value = 0.05). Similarly, the type of family (p value = 0.005), age of the children (p value = 0.000) and type of CHD (p value = 0.002) were significantly associated with the level of burden of care among the mothers. Conclusion: The study concluded that mothers tend to feel less burden of care as the child grows older, mothers having children with cyanotic heart disease tend to experience more burden of care. Mothers of less than thirty years of age and living in a joint family also experience more burden of care.

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