APP-First: A Care Delivery Model Designed to Increase Access and Treatment Opportunities for Patients with...

Advanced Practice Provider (APP)-First is a delivery of care model implemented at our institution where APPs see new patients as an entry into the system to complete any missing diagnostic testing prior to appointment with the surgical oncologist. The program's purpose was to increase capacity, expedite care, and best prepare the patient's workup to facilitate treatment initiation.

A retrospective review was performed focusing on the hepatobiliary and pancreatic surgical team. New patient (NP) volume, percentage of patients electing to receive care at our institution, and treatments received after first visit were evaluated before and after implementation of the program. The primary outcome, impact on access, and the secondary outcomes were number and proportion of patients receiving treatment at our institution.

A total of 2585 NPs were seen during the study periods. During the pre-intervention period, 1091 NPs were seen by the group, including 277 (25.5%) initially evaluated by an APP. Following implementation, 1494 NPs were seen, 915 (61.2%) by an APP (p < 0.001). There was no change in percentage of NPs choosing to pursue care at our institution (68.7% versus 68.7%, p = 0.970), however, after implementation, patients were more likely to be scheduled for operations after their initial visit (11.4% versus 14.3%, p = 0.031).

Implementation of the APP-First program led to increased NP capacity, translating into 36.9% increased access and resulting in expedited treatment initiation. This program reinforces the role of APPs into a well-integrated system, with overall improved capacity, access, and treatment for patients with cancer.