APP-first as a strategy to increase new patient access and treatment of patients with gastrointestinal malignancies within a cancer center.

Abstract

1534 Background: Quality cancer care depends on timely and efficient evaluation of patients to determine next steps in treatment. To support this goal, we implemented a care delivery model where advanced practice providers (APP) were tasked with seeing new patients as an entry into the system, with a goal of completing testing and referrals prior to a subsequent visit with a surgical oncologist. Methods: A retrospective review was performed focusing on four hepatobiliary and pancreatic surgeons and their corresponding APP teams. The APP-First program was deployed in 2021. The purpose was to increase capacity and best prepare the patient’s work-up prior to an appointment with the surgeon to facilitate treatment initiation. We compared NPs during two distinct time periods, before (7/2018-6/2020) and after (7/2022-6/2024) implementation of APP First . The primary outcome, impact on access, was determined by change in the number of NP seen by the group, and the secondary outcomes were number and proportion of patients receiving treatment at our institution. Patients were excluded if time to care was > 180 days or they received non-GI related care. Changes in outcomes of interest before and after implementation of the program were compared by Chi-square with significance set at p = 0.05. Results: A total of 2585 NPs were seen during the study period with 1797 beginning treatment at our facility (69.5%). During the pre-intervention period 1091 NPs were seen by the group, including 277 (25.5%) initially evaluated by an APP. Following the model implementation, 1494 NPs were seen, 915 (61.2%) by an APP and 579 (38.8%) by an MD (p < 0.001). There was no change in percent of NPs choosing to pursue care at our institution (68.7% vs 68.7%, p = 0.970), however after implementation, patients were more likely to be scheduled for operations after their initial visit (11.4% vs 14.3%, p = 0.031). Conclusions: Implementation APP-first led to increased NPs capacity translating into a 36.9% higher volume of NPs seen, without change in patient satisfaction as demonstrated by an unchanged percentage of patients choosing treatment at our institution. The established workflow within this model facilitated expedited care, resulting in higher proportion of patients treated and an increase in the number and proportion of patients receiving surgery. These data support the implementation of delivery of care models leveraging the role of APPs in a well-integrated system, with overall improved capacity, access, and treatment for patients with cancer. Outcomes of APP-First program. FY 19-20 (n,%) FY 23-24 (n,%) p value Total # NP 1,091 1,494 -- NP Distribution APP MD 277 (25.4)814 (74.6) 915 (61.2)579 (38.8) <0.001 Treated Yes No 750 (68.7)341 (31.3) 1026 (68.7)468 (31.3) 0.970 Surgery 124 (11.4) 213 (14.3) 0.031 Chemotherapy 143 (13.1) 194 (13.0) 0.928 Endoscopy 376 (34.5) 466 (31.2) 0.080 Radiation 112 (10.3) 154 (10.3) 0.972