Congress Abstracts 2006

33

INTEGRATED ONCOLOGY CARE: MEASURING AOCNP PRACTICE OUTCOMES. Judith Much, RN, AOCNP, the Cancer Institute of New Jersery, New Brunswick, NJ; and Gregory Harper, MD, Krista Casey, and Thomas Wasser, PhD, Lehigh Valley Hospital and Health Network, Allentown, PA.

Inpatient oncology care is expensive and often characterized by discontinuity and fragmentation of services. In 2003 a proposal was funded to improve the care of hospitalized heme/onc patients at this major community teaching hospital. The Integrated Oncology Care (IOC) initiative supported a nurse practitioner ("NP") to develop, pilot, and implement a collaborative practice model with Oncology and Hematology attending physicians.

The purpose of the project was to reduce costs, LOS (length of stay), and practice variation, as well as to increase patient and provider satisfaction through the interventions of an NP.

With the IOC steering committee, the NP identified need for and developed symptom management protocols, rounded daily with oncology attendings to provide continuity of care, held daily nursing rounds with staff, entered orders, provided "hospitalist" support to staff and patients for medical emergencies and other issues when attendings were not on the unit, and provided patient and family communication on medical, symptom management and supportive issues. For six months after project initiation, the NP observed and developed the practice model and a plan for piloting the intervention. Pilot intervention took place over 6 months with both oncology practices. After evaluation of the pilot, the NP worked only with one of the oncology practices for an additional 6 months. Data was collected for a variety of outcomes including total costs (TC), variable costs (VC) and LOS.

Although TC decreased over baseline during the intervention period, it was not statistically significant. However VC were reduced by over $1300/case for both oncology practices: p<0.032 in one group and p<0.059 on the other. The LOS in the group with the NP intervention at the second six month time point was significantly less (p<0.037) than the "control" group. Decrease practice variation was seen in reduction in standard deviation in all measures.

The clinical expertise of an oncology NP can make a significant contribution to inpatient care to patients, staff, and the institution through provision of continuity of care and expert clinical judgment. At a time when hospital costs are rising, the contributions that can be made by NPs can be well worth their salary.