Combined use of advanced practice providers and care pathways reduces the duration of stay after surgery for gastrointestinal malignancies

Broman, Kristy Kummerow; Baez, Hansel; Mihelic, Erin; Zhu, Sarah; Dineen, Seán; Fleming, Jason B.; Anaya, Daniel A.; Pimiento, José M.

doi:10.1016/j.surg.2020.06.015

Cited by 5 publications

(10 citation statements)

References 9 publications

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“…Although small numbers of patients in this sample showed low health literacy, BRIEF scores were still related to longer hospital LoS and greater postacute care needs when accounting for the sociodemographic and clinical variables that were significantly related to outcomes of interest. Even at an NCI-designated CCC that has incorporated perioperative interventions that reduce LoS after surgery, 41 we still observed differences in clinical outcomes by level of health literacy. Thus, our second hypothesis was partially supported.…”

Section: Discussionmentioning

confidence: 72%

Health Literacy in Surgical Oncology Patients: An Observational Study at a Comprehensive Cancer Center

Rothermel

Conley

Sarode

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: Low health literacy is associated with increased resource use and poorer outcomes in medical and surgical patients with various diseases. This observational study was designed to determine (1) the prevalence of low health literacy among surgical patients with cancer at an NCI-designated Comprehensive Cancer Center (CCC), and (2) associations between health literacy and clinical outcomes. Methods: Patients receiving surgery (N=218) for gastrointestinal (60%) or genitourinary cancers (22%) or sarcomas (18%) were recruited during their postsurgical hospitalization. Patients self-reported health literacy using the Brief Health Literacy Screening Tool (BRIEF). Clinical data (length of stay [LoS], postacute care needs, and unplanned presentation for care within 30 days) were abstracted from the electronic medical records 90 days after surgery. Multivariate linear and logistic regressions were used to examine the relationship between health literacy and clinical outcomes, adjusting for potential confounding variables. Results: Of 218 participants, 31 (14%) showed low health literacy (BRIEF score ≤12). In regression analyses including 212 patients with complete data, low health literacy significantly predicted LoS (β = −1.82; 95% CI, −3.00 to −0.66; P=.002) and postacute care needs (odds ratio [OR], 0.25; 95% CI, 0.07–0.91). However, health literacy was not significantly associated with unplanned presentation for care in the 30 days after surgery (OR, 0.51; 95% CI, 0.20–1.29). Conclusions: This study demonstrates the prevalence of low health literacy in a surgical cancer population at a high-volume NCI-designated CCC and its association with important clinical outcomes, including hospital LoS and postacute care needs. Universal screening and patient navigation may be 2 approaches to mitigate the impact of low health literacy on postsurgical outcomes.

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Section: Discussionmentioning

confidence: 72%

Health Literacy in Surgical Oncology Patients: An Observational Study at a Comprehensive Cancer Center

Rothermel

Conley

Sarode

et al. 2021

Journal of the National Comprehensive Cancer Network

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“…We characterized studies according to the presence and nature of patient-mix adjustment (PMA; see hcahpsonline.org for further details). We assumed that a study used a standard PMA if the study described applying HCAHPS PMA with reference to the standard CMS methodology (e.g., Broman et al, 2021) or if HCAHPS data were downloaded from Care Compare, which report only fully adjusted HCAHPS scores. Standard PMA includes patient education, self-rated overall health, self-rated mental health (added 2018), response percentile, survey language, and interactions of service line with age and sex.…”

Section: Classifying Studiesmentioning

confidence: 99%

“…Advanced practice provider/care pathways (Broman, 2021) Certified electronic health records (Hu et al, 2020) Structure Rural status (Hu et al, 2020) Nonprofit (Hu et al, 2020)…”

Section: Processmentioning

confidence: 99%

Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence

Beckett,

Quigley,

Lehrman

et al. 2024

Med Care Res Rev

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Patient experience is a key hospital quality measure. We review and characterize the literature on interventions, care and management processes, and structural characteristics associated with better inpatient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Prior reviews identified several promising interventions. We update these previous efforts by including more recent peer-reviewed literature and expanding the review’s scope to include observational studies of HCAHPS measures with process measures and structural characteristics. We used PubMed to identify U.S. English-language peer-reviewed articles published in 2017 to 2020 and focused on hospital patient experience. The two HCAHPS domains for which we found the fewest potential quality improvement interventions were Communication with Doctors and Quietness. We identified several modifiable processes that could be rigorously evaluated in the future, including electronic health record patient engagement functionality, care management processes, and nurse-to-patient ratios. We describe implications for future policy, practice, and research.

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“…Advanced practice clinicians (APCs), defined as nurse practitioners and physician assistants, are increasingly being incorporated into surgical teams. 8 , 9 , 10 , 11 , 12 , 13 Despite this inclusion, there are no recent national data on the role of these clinicians in surgical opioid prescribing or the dosing of their surgical opioid prescriptions. In one of the few studies on these topics, APCs wrote one-fifth of opioid prescriptions within 30 days of surgery among adult opioid-naïve patients and private insurance in Michigan who underwent surgical procedures between 2012 and 2015.…”

Section: Introductionmentioning

confidence: 99%

“…Advanced practice clinicians (APCs), defined as nurse practitioners and physician assistants, are increasingly being incorporated into surgical teams . Despite this inclusion, there are no recent national data on the role of these clinicians in surgical opioid prescribing or the dosing of their surgical opioid prescriptions.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Opioids Prescribed by Advanced Practice Clinicians vs Surgeons After Surgical Procedures in the US

et al. 2023

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ImportanceAdvanced practice clinicians (APCs), defined as nurse practitioners and physician assistants, are increasingly being incorporated into surgical teams. Despite this inclusion, there are no recent national data on the role of these clinicians in surgical opioid prescribing or the dosing of such prescriptions.ObjectiveTo calculate the proportion of surgical opioid prescriptions written by APCs and to compare the total and daily dosages of these prescriptions with those written by surgeons.Design, Setting, and ParticipantsThis cross-sectional study used the Optum’s De-Identified Clinformatics Data Mart, which contains deidentified claims from patients with private insurance and Medicare Advantage plans across the US. Adults and children who underwent 1 of 31 inpatient and outpatient surgical procedures from January 1, 2017, through November 30, 2019, were identified. The analysis was limited to procedures with 1 or more perioperative opioid prescriptions, defined as an opioid prescription dispensed within 3 days of the index date of surgery. Data were analyzed from April 1, 2021, to July 31, 2022.ExposuresPrescriber specialty.Main Outcomes and MeasuresThe outcome was the proportion of perioperative opioid prescriptions and refill prescriptions written by APCs. Linear regression was used to compare the total dosage of perioperative opioid prescriptions written by APCs vs surgeons measured in morphine milligram equivalents (MMEs). Models were adjusted for demographic characteristics, comorbidities, opioid-naive status, year of index date, hospitalization or observation status, surgical complications, and surgeon specialty. Analyses were conducted at the procedure level, and patients with multiple procedures were included.ResultsAnalyses included 628 197 procedures for 581 387 patients (358 541 females [57.1%]; mean [SD] age, 56 [18] years). Overall, APCs wrote 119 266 (19.0%) of the 628 197 perioperative opioid prescriptions and 59 679 (25.1%) of the 237 740 refill prescriptions. Perioperative opioid prescriptions written by APCs had higher total dosages compared with those written by surgeons (adjusted difference, 40.0 MMEs; 95% CI, 31.3-48.7 MMEs). This difference persisted in a subgroup analysis limited to opioid-naïve patients (adjusted difference, 15.7 MMEs; 95% CI, 13.9-17.5 MMEs).Conclusions and RelevanceIn this cross-sectional analysis, one-fifth of perioperative opioid prescriptions and one-quarter of refill prescriptions were written by APCs. While surgeons wrote most perioperative opioid prescriptions that were intended for perioperative analgesia, higher total dosages from APCs suggest that opioid stewardship initiatives that support the role of APCs may be warranted.

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Combined use of advanced practice providers and care pathways reduces the duration of stay after surgery for gastrointestinal malignancies

Cited by 5 publications

References 9 publications

Health Literacy in Surgical Oncology Patients: An Observational Study at a Comprehensive Cancer Center

Health Literacy in Surgical Oncology Patients: An Observational Study at a Comprehensive Cancer Center

Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence

Comparison of Opioids Prescribed by Advanced Practice Clinicians vs Surgeons After Surgical Procedures in the US

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