240 A Retrospective Review Comparing Outcomes of Patients Receiving Reinduction Therapy On House Staff and PA Services

Track: BMT Clinical Education Conference (for NPs, PAs, Fellows and Junior Faculty)
Saturday, February 16, 2013, 3:30 PM-4:45 PM
255 A-C (Salt Palace Convention Center)
Deborah Yolin Raley, PA-C, MS , Bone Marrow Transplant, Dana-Farber Cancer Institute, Boston, MA
Brett Glotzbecker, MD , Medicine - Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
Daniel Deangelo, MD , Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
Richard Stone, MD , Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
Robert J. Soiffer, MD , Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
Edwin P. Alyea III, MD , Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
Background:

Historically, inpatient academic medical center (AMC) patient care has been delivered by faculty physicians in conjunction with physicians-in-training (house-officers or HO). Alternative staffing models have emerged secondary to Accreditation Council for Graduate Medical Education work-hour restrictions. Our institution expanded the Physician Assistant (PA) inpatient oncology services to accommodate such changes. The purpose of this study was to assess the quality of subspecialized leukemia care provided by our PA service compared to traditional HO models.

Methods:

Data was retrospectively collected on all patients admitted to the HO or PA hematologic malignancy services for re-induction chemotherapy for acute myelogenous leukemia from January 2008 through January 2012. The same attending pool rotated on both the HO and PA services. Primary outcome measures were length of stay and mortality. Secondary outcomes included readmissions within 14 and 30 days, ICU transfers, number of consults requested, and total studies ordered (CXR, CT MRI and Ultrasound).

Results:

During the study period, 95 patients were admitted for re-induction chemotherapy. Forty-seven patients (49.5%) were admitted to HO and 48 patients (50.5%) admitted to PAs. Demographic data was similar between the two services. Length of stay was significantly different between the two services with a mean of 36.8 days on the HO service compared to 30.9 days on the PA service (p=0.03). The 14 day readmission rates also differed significantly and were 10.6% (5/47) for HO services and zero for the PA service (p=0.03). The mean number of consults on the HO was 2.11 (0-5 consults) versus 1.47 (0-4 consults) on the PA service (p=0.03). Mortality, ICU transfers, and the numbers of radiologic studies ordered were not significantly different between the two groups.

Discussion:

The data suggests equivalent mortality rates and ICU transfers in the two models with a decrease in length of stay and readmission rates for those cared for on the PA service. In order to verify these results, a prospective randomized trial comparing the two care models is needed.

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