Collaboration of the Hybrid AF Patient: Role of Advanced Practice Providers Jennifer Walker, RN, MSN, ANP-BC UNC Center for Heart and Vascular Care
Conclusions New paradigm has shifted towards team-based care Contributions of Advanced Practice Providers (APPs) essential to team-based care Future studies needed to solidify benefits of APPs in cardiovascular team-based approach Hybrid AF Team at UNC prime example of collaboration between EP and CT surgery, with APPs as liaison between both services and the patients
Continuum of Healthcare Practice Models Parallel Practice Collaborativ e Multidisciplinary Integrative Consultative Coordinated Interdisciplinary New Paradigm: Team-Based Care Increases: -Synergy -Complexity -Diversity of outcomes Decreases: -Hierarchy -Clearly defined roles -Autonomy Boon et al. BMC Health Services Research 2004 4:15
http://www.acc.org/membership/member-benefits-and-resources/acc-member-publications
2015 ACC Health Policy Statement on Cardiovascular Team- Based Care and the Role of Advanced Practice Providers Purpose: To inform ACC members and public about capabilities of APPs Offer successful examples and discuss barriers to cardiovascular team-based care Provide recommendations for improving delivery of cardiovascular team-based care J Am Coll Cardiol. 2015;65(19):2118-2136. doi:10.1016/j.jacc.2015.03.550 Date of download: 8/9/2015 Copyright The American College of Cardiology. All rights reserved.
Capabilities of APPs All taught problem-solving algorithms, treatment protocols, and standards for cardiovascular care. Different backgrounds offer diversity to the team: NPs - chronic disease management PAs - modeled on the technical and clinical tasks of the physicians PharmDs - complex drug therapy J Am Coll Cardiol. 2015;65(19):2118-2136. doi:10.1016/j.jacc.2015.03.550
Examples of Cardiovascular Team- Based Care Utilizing APPS Setting Hospital Admission / DC CHF Management Lipid and HTN Clinics Anticoagulation Clinics Stress testing labs Structural heart programs Arrhythmia management for PM / ICDS Outreach to rural clinics / remotes locations Advantage of Team Base Care Reduced readmission rates Reduced hospitalizations, reliable use of EBM therapies, patient education Reliable use of EBM therapies, consistent documentation of lifestyle education Improved patient safety through reliable education, drug interaction monitoring Efficient use of workforce Improved access and care coordination Improved access and care coordination Improved access and care coordination J Am Coll Cardiol. 2015;65(19):2118-2136. doi:10.1016/j.jacc.2015.03.550 Date of download: 8/9/2015 Copyright The American College of Cardiology. All rights reserved.
Barriers to broad dissemination of cardiovascular team-based care: Payment Barriers- Medicare reimbursement, commercial payers Regulatory Barriers- wide variability in prescriptive authority and licensure among APPs J Am Coll Cardiol. 2015;65(19):2118-2136. doi:10.1016/j.jacc.2015.03.550
Requirements for Physician Involvement for Advanced-Practice Registered Nurses * PAs & Pharmacists need MD supervision in all states Igleharrt, J. N Engl J Med 2013; 368:1935-1941
Recommendations for improving the delivery of cardiovascular teambased care: Form task force to focus on CV training for APPs Reach national consensus on training and core competencies Expand inter-professional education Advocate for sensible payment reforms Explore emerging technologies that extend CV teambased care virtual teams, telemedicine J Am Coll Cardiol. 2015;65(19):2118-2136. doi:10.1016/j.jacc.2015.03.550
Hybrid AF Ablation at UNC + =
The Hybrid AF Team at UNC: Shared goals and clear roles MDs- CT surgeon, EP, fellows NP/PAs: EP and CTS Dedicated AF Coordinator (RN) Dedicated scheduling center (RN) EP lab/ OR staff Cardiac anesthesia Nursing- bedside care Clinical Pharmacist Case Manager Nutritionist, PT/OT, Chaplain Patient- team leader
Role of APPs in Care of Hybrid AF Patient Intraop Postdischarg e issues Post-op managem ent Clinic visits Patient Multidisciplin ary team meeting Pre-op evaluati on
Conclusions New paradigm has shifted towards team-based care Contributions of Advanced Practice Providers (APPs) essential to team-based care Future studies needed to solidify benefits of APPs in cardiovascular team-based approach Hybrid AF Team at UNC prime example of collaboration between EP and CT surgery, with APPs as liaison between both services and the patients
Thank you! Dr. Paul Mounsey Dr. Anil Gehi Dr. Eugene Chung Dr. James Hummel Dr. F. Roosevelt Gilliam Tiffany Armbruster, NP Connie Fecik, NP Kimberly Guise, NP Gail Ho, NP Jennifer Walker, NP
Collaborative Patient and Family Coordination Kelly Garner, RN, AF Clinical Coordinator UNC Center for Heart and Vascular Care
Defining Patient and Family Collaboration Patient and family centered care is an approach to the planning, delivery and evaluation of health care that is grounded in mutually beneficial partnerships among patients, families, and health care practitioners. It is founded on the understanding that the family plays a vital role in ensuring the health and well being of patients of all ages. American Hospital Association
Components of Patient and Family Collaboration
Principles of Patient and Family Centered Care Dignity and Respect Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care. Information Sharing Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making. Participation Patient and families are encouraged and supported in participating in care and decision-making at the level the chose. Collaboration Patients, families, health care practitioners, and hospital leaders collaborate in policy and program development, implementation and evaluation; in health care facility design; and in professional education, as well as in the delivery of care.
10 Guidelines for Collaboration 1. Care based on continuous healing relationships. 2. Customization based on patient needs and values 3. The patient as the source of control. 4. Shared knowledge and the free flow of information. 5. Evidence-based decision making. 6. Safety as a system property. 7. The need for transparency. 8. Anticipation of needs. 9. Continuous decrease in waste. 10.Cooperation among clinicians. Adapted from Institute of Medicine, Crossing the Quality Chasm: A New Health Care System for the 21 st Century, 2001. Washington, D.C. National Academy Press.
The ultimate goal of patient-and family-centered care is to create partnerships among health care practitioners, patients and families that will lead to the best outcomes and enhance the quality and safety of health care. American Hospital Association
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