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Int J Pediatr Otorhinolaryngol. 2019 Nov 7;129:109770. doi: 10.1016/j.ijporl.2019.109770. [Epub ahead of print]

Advanced practice providers and children's hospital-based pediatric otolarynology practices.

Author information

1
Children's Hospital Colorado, Aurora, CO, USA; Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: Kenny.Chan@childrenscolorado.org.
2
Children's Hospital Colorado, Aurora, CO, USA; Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
3
CHOC Children's Hospital, Orange, CA, USA; Department of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, CA, USA.
4
Division of Otolaryngology - Head and Neck Surgery, University of New Mexico, Albuquerque, NM, USA.
5
Rady Children's Hospital, San Diego, CA, USA; Department of Otolaryngology - Head and Neck Surgery, Naval Medical Center San Diego, San Diego, CA, USA.
6
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA; Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
7
Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
8
Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.
9
Department of Otolaryngology, Dayton Children's Hospital, Dayton, OH, USA.
10
Texas Children's Hospital, Houston, TX, USA; Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
11
Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
12
Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
13
Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA.
14
Children's Minnesota, St. Paul, MN, USA.
15
Lucille Packard Children's Hospital, Palo Alto, CA, USA; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, CA, USA.
16
Children's Health, Dallas, TX, USA; Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
17
Primary Children's Hospital, Salt Lake City, UT, USA; Division of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
18
Arkansa Children's Hospital, Little Rock, AR, USA; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
19
Benioff Children's Hospital, San Francisco, CA, USA; Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA.
20
Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA; Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
21
Seattle Children's, Seattle, WA, USA; Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, USA.
22
Molecular Otolaryngology and Renal Research Laboratories, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
23
Children's Hospital of Wisconsin, Milwaukee, WI, USA; Department of Otolaryngology and Communication Sciences, Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, USA.
24
LeBonheur Children's Hospital, Memphis, TN, USA; Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
25
C.S. Mott Children's Hospital, Ann Arbor, MI, USA; Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.
26
Nemours Children's Hospital, Orlando, FL, USA; Department of Otolaryngology - Head and Neck Surgery, University of Central Florida College of Medicine, Orlando, FL, USA.
27
Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Otolaryngology - Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
28
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
29
Children's National Health System, Washington, DC, USA; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
30
Connecticut Children's Medical Center, Hartford, CT, USA; Department of Otolaryngology - Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, CT, USA.

Abstract

INTRODUCTION:

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.

METHODS:

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.

RESULTS:

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.

DISCUSSION:

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.

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