update from the national marrow donor program 2013 hematopoietic stem cell transplant advanced...
TRANSCRIPT
Update from the National Marrow Donor Program
2013 Hematopoietic Stem Cell Transplant Advanced Practice Providers Conference
Eneida R. Nemecek, MD, MBASeptember 12, 2013
Financial Disclosure – NoneSpeaker is a member of the NMDP Board of Directors
System Capacity Initiative
Description
• Analysis of the U.S. health care system’s capacity to support a 2- to 3-fold increase in patients needing transplant by 2020*
• System Capacity Initiative- Collaboration by representatives of all stakeholders of
HCT- Recommendations and solutions for issues affecting the
delivery of HCT
* Analysis by NMDP and CIBMTR estimates a need of 10,000 transplants based on current indications in patients up to age 60.
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Transp
lants
Transplant Activity in the U.S.1980-2010
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
'80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03'04' '05 '06 '07 '08 '09 '10
AutologousRelated DonorUnrelated Donor
Pasquini MC, Wang Z. Current use and outcome of hematopoietic stem cell transplantation: CIBMTR Summary Slides, 2011.
NMDP Transplants Facilitated to Date
4 4
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87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
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96
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97
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20
00
20
01
20
02
20
03
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06
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0
1000
2000
3000
4000
5000
6000
7000
Num
ber
of T
rans
plan
ts
The Need
• By applying the optimal transplant rate to the U.S. population, the need for allogeneic (related and unrelated) transplant is 18,000 per year.
– Related – 5,500 per year
– Unrelated – 12,500 per year
5.5
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Population Growth: 2000 to 2020
0%
10%
20%
30%
40%
50%
60%
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Per
cent
Gro
wth
(Rel
ativ
e to
200
0)
Age 0-64 Age 65-84 Age 85+ Total
U.S. Census Bureau
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
0 - 10 Years
11 - 17 Years
18 - 30 Years
31 - 40 Years
41 - 50 Years
51 - 64 Years
Over 64 Years
Transplants by Recipient Age
2001 2003 2005 2007 2009 2011
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Increasing indications and increasing age
Improved survival of older allogeneic HCT recipients
Kurosawa et al. BBMT 2011, 17:401-4118
0
50
100
150
200
250
300
350
400
450
AFA API Hispanic Am Ind
Transplants by Recipient Race
2003 2004 2005 2006 2007 2008 2009 2010 2011
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The call for a diverse workforce
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Goals of SCI
Assess current system capacity challenges and make recommendations to support growth:
• Define and prioritize initiatives to meet human resource and infrastructure demands- Number and type of clinicians- Facility capacity- Financial support needed
• Explore novel models for delivery of care to improve efficiency and effectiveness
• Identify capacity issues that may limit access to HCT for diverse and underserved populations
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System Capacity Initiative Program Organization and Participants
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Professional Organizations and Stakeholder Engagement
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System Capacity Initiative Program Schema
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Year 4: A Workforce Summit is being planned for Tuesday, November 19, 2013.
Common Findings from Workforce Groups
• Inadequate number of providers• Lack of awareness among those in training of
transplant as a career option– Reduction over time of exposure to transplant as
training priorities change and the complexity of transplant care increases
• Large variation in the membership and use of the care team between centers– Lack of benchmarks on effective and efficient use
of workforce
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Common Recommendations
• Early exposure to transplant in training– Clinicians and researchers should convey the
positive aspects of the profession to trainees
• Diverse exposure to outpatient as well as inpatient care
• Optimal use of each professional group on the multidisciplinary transplant team
• Promoting the multi-disciplinary nature of the transplant team
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Common Recommendations
• Retention issues– Compensation/benefits/burnout/compassion fatigue– Work/life balance
• Efficiency/effectiveness– Use of benchmarks to assess work effort to
compare to other centers and other specialties
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Advanced Practice Professionals
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NMDP – NP/PA SCI Working Group
• Monthly conference calls
• SCI Steering Committee and Working Groups met annually at 1½ day symposia to present and evaluate recommendations from each group – Symposium 1 – Chicago 2010– Symposium 2 – Minneapolis 2011– Symposium 3 – Minneapolis 2012– Symposium 4 – Minneapolis 2013 (Nov 19)
To view presentations, more information:http://marrow.org/HD/SCI/SCI_Symposia.aspx
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NMDP – NP/PA SCI WG Year 1 Summary
• Survey • Pilot in NP/PA school
• Needs assessment of NP/PA – 2011 Tandem
• Began to assemble smaller working groups
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Year 1 Survey
• 224 NP/PA (45% response rate)
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Year 1 NP/PA NMDP WGSurvey Highlights
• Data Highlights
– Full time 97% work more than 40 hrs per week
– 74% have less than 10% non-clinical time• research, committee, education, administrative
– 69% of NP/PA schools have no HemOnc/BMT course
– 48% NP/PA transferred from other positions to HCT
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Year 1 NP/PA NMDP WGSurvey Highlights
• Job satisfaction & retention– 41% will/might reduce hours– 30% will/think of changing jobs– 24% are thinking about a career change
• 79% feel BMT MDs are interested in having them perform higher roles in patient care, and that they are not working to top of their license
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Year 1 NP/PA NMDP WGSurvey Highlights
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Year 1 NP/PA NMDP WGSurvey Highlights
• Top most satisfying aspect of working in HCT– Intellectual stimulation of patient care– Emotional gratification of patient care– Intellectual stimulation of research/new discovery
• Top least satisfying aspect of position– Job related stress/work demands– Burn out related to sick and dying patients– Excessive work hours – Insufficient salary
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Both mirror MD survey responses
Year 1 NP/PA - Needs assessment at Tandem 2011
Needs assessment completed for NPs/PAs at Tandem
– 70% of attendees at Tandem were interested in opportunities for NPs/PAs to network outside of their own institution
– 100% felt the profession would benefit from creating a national HCT SIG through ASBMT
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Year 1 Education Pilot NP/PA schools
HCT 101 Lecture in NP/PA schools– 1st and 2nd year students received HCT 101 lecture
– Students were surveyed prior and post lecture• Regardless of year in schooling, were more likely to
pursue a career in HCT after the lecture
– Impact greater on first year students
– Generated interest in shadowing or clinical rotations
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NMDP NP/PA - Year 2 Summary
• Sub-groups formed within NMDP NP/PA WG to address following needs:
– Education
– Compensation/benefits
– Collaboration with NMDP and other groups
– Defining the role of NP/PA in HCT
– Work models for NPs/PAs
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Optimal Work Model and Role Definition Documents
Designed to support:
• Current NPs/PAs in HCT practice
• NP/PA students interested in a career
• Recruitment of currently practicing PAs/NPs
• HCT MDs, program directors and administrators in the utilization of NPs/PAs
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Recommendations for Optimal Work Models for Physician Assistants and Nurse Practitioners Working in Hematopoietic Cell Transplantation
• Recommendations on:• Work hours / schedule• Multidisciplinary support staff• Patient care models• Salary / compensation• Professional development and support
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Role of the Physician Assistant/Nurse Practitioner in Stem Cell Transplantation
Provide quality care to BMT patients in conjunction with the patient’s physician and care team under the guidelines established by their institutions, ASBMT, NMDP and current best practices in medicine
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Care Delivery – NP/PA’s Outpatient Role
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1-35 HCTN=18
36-75 HCTN=18
76-130 HCTN=17
131-190 HCTN=14
>190 HCTN=18
Center Size(HCT/year)
No NP/PA’s in outpatient clinic
See patients independently
See patients and staff with MD
NP/PA’s role in outpatient clinic, %
Courtesy of Dr. Navneet Majhail
???
Advanced Practice Professionals Top Initiatives
• Creation and structuring of a more in-depth ASBMT APP Steering Committee organizational structure
• Dedicated web page for APPs through the ASBMT website; identifying, defining and developing content for the site
• Continuing outreach to students and APPs working in other fields, to increase awareness of HCT with the intent to positively impact recruitment and retention
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Expand the ASBMT APP Steering Committee
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Created 4 new working groups1. Education 2. Research 3. Website development4. Liaison positions
• APAO• APHON• ONS
ASBMT NP/PA Org Structure
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ONS - Oncology Nursing SocietyAPAO - Association of PAs in Oncology APHON - Association of Pediatric Hematology/Oncology Nursing
Development of a webpage for APPs
Content development in process in the following areas:1. Education
• APP guidelines, HCT 101, ASBMT COE PIMs, etc.
2. Students/careers• Job search, student rotations, link to graduate programs, APP role in
HCT document, links to education
3. Employer focused• Work model recommendations, discussion forum
4. APP - Who we are
5. Discussion/Forum• Bi-annual newsletter, professional practice issues, blogs, etc.
6. Membership
7. Research opportunities
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Educational Outreach
Current• Collaborating with ASBMT Committee on Education (COE)
– NP/PA Training Guidelines, Tandem Meeting
• Tandem 2013 – first NP/PA abstract session – Research working group formed (QI and clinical projects)
• HCT 101 Lecture Video – Dr. Cutler• Website development and links within ASBMT/NMDP
– NMDP Clinical Lecture Series
Future • Educational efforts with APAO, ONS and APHON partnership• NP/PA school collaboration for teaching• Brochure to NP/PA schools with access to HCT 101/other lectures• Clinical rotations – learn from existing and create more • Consider regional conferences and educational opportunities outside BMT
Tandem Meetings
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Training Guidelines
American Society of Blood and Marrow Transplantation (ASBMT): Guidelines for
Training in Hematopoietic Progenitor Cell Transplantation for Nurse Practitioners and
Physician Assistants (NPs/PAs)
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Collaborations –internal and external
• Formal liaison positions created with national NP/PA organizations – Oncology Nursing Society (ONS)– Association of PAs in Oncology (APAO)– Association of Pediatric Hematology/Oncology Nursing (APHON)
• ASBMT Committee on Education – NP/PA liaison
• Working Committees/Task Force – NP/PA reps
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Challenges • We need your help
– Join the efforts of the working group• Mentoring• SIG Committees• Education: Penetrate NP/PA schools early
Engage multidisciplinary learners
• We need more data – Participate in surveys– Defining optimal work models and how to support changes in
practice so NPs/PAs can work at “top of license”
• We can create demand….are centers ready to increase supply?– BMT supply/demand and ACGME regulatory changes– Facility constraints
What can you do?
• Join ASBMT if you are not a member– 182 NPs/PAs registered at Tandem 2013– 49 NP/PA SIG members total
• Volunteer to join a working group
• Help spread the word to your colleagues
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NMDP SCI Working Group Members• Members
– Susan M. Burroughs, PA-C– Gilbert Ciocci, NSN, FNP-BC– Theresa Donohue, PA– Julia Gourde, RN, CNP– Amy Joyce, MSN, ANP, AOCN– Shelly Mentzer, MMS, PA-C– Jerelyn Moffet, CPNP– Eneida Nemecek, MD, MBA– Nancy Shreve, NP, MS, FNP– Susan Slater, MN, FNP-BC– Kristin Sterling, APRN-BC– Cindy Treviño, ANP-BC,
AOCN
• Chair– Deborah Yolin Raley, PA-C
• Vice Chair– Erin Medoff, APRN
• NMDP Lead Staff – Jason Dehn, MPH, CHTC – Megan Cooper, BS, CHTC– Joan Jarosh (admin.)
• Special Thanks– Paula Cuthrell NP– Colleen Brown PA– Melissa Cochran NP– Thomas Joseph ASBMT
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ASBMT Steering Committee APP SIG 2013
• Paula Cuthrell, CNP, CFNP, Chair
• Michael Wilson, PA-C, Past-Chair
• Susan Burroughs PA-C, Chair-elect
• Colleen Brown PA-C• Lori Burton, MSN,
CPNP• William Levy, PA-C
• Jackie Lagerlof, MS, PA-C
• Ashley Miller, RN, MSN, FNP-BC, AOCNP, MPH
• Carina Moravec, ARNP • Amy Witter, PA-C• Deborah Yolin-Raley,
PA-C• Amy Klingler, PA-C, ex-
officio
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