Advanced Hematologic Malignancy Outpatient Service (AHOPS)
DESCRIPTION
Patients with hematologic malignancies often have unpredictable and intensive care needs. Patients with leukemia, for example, require frequent infusion appointments but cannot always be seen by a provider before their infusion, so treatment plan decisions must often be made remotely between infusion RNs and the care team. This disconnect leads to disrupted workflows for infusion RNs and providers, scheduling challenges and delays experienced by patients on the day of their infusion appointments. Additionally, these patients are often hospitalized for treatment that could have been administered as outpatient care, contributing to more inpatient bed unavailability.
Seeking to address these problems, the selected 2022 Cancer Service Line (CSL)-PC3I Access Accelerator project explored solutions to improve access to and delivery of outpatient hematologic oncology care. The project, led by Alfred Garfall, Assistant Professor of Medicine and Director of Autologous Hematopoietic Stem Cell Transplantation at the University of Pennsylvania, focused on providing a dedicated Advanced Practice Provider (APP) to staff infusion chairs at the Perelman Center for Advanced Medicine. Through a dedicated workflow and scheduling pathway, this APP could evaluate and treat acute leukemia patients with supportive services directly in the infusion suite.
IMPACT
While initially staffed and supported by PC3I project managers, this project has grown since its launch and has since implemented an APP-led clinic embedded in infusion to improve care coordination and delivery for patients with leukemia receiving infusion therapy. Patient feedback from the project was overwhelmingly positive—showing 100% of respondents who reported that their needs were met, they felt cared for, and they were very likely to recommend their assigned provider. Further opportunities for the APP model could include support for transitioning complicated inpatient treatments, such as chemotherapy, CAR-T therapy, and bispecific antibodies, to outpatient settings.
FUNDING
Cancer Service Line (CSL) & Penn Center for Cancer Care Innovation (PC3I) Access Accelerator
PEOPLE
Alfred Garfall, MD; Keith Pratz, MD; Katie Allen, MS; Amy Brazina, MBA; Justin Bekelman, MD; Donna Capozzi, PharmD, BCOP; Carlin Cialino, BSN, RN, OCN; Kerry Coughlin, MSW; Neil Crimins, MBA; David Dougherty, MD, MBA; Kevin Enterlin, CRNP; Noelle Frey, MD, MS; Patrick Higgins, MHA; Meagan Hume, MDP; Catherine Lai, MD, MPH; Suzanne McGettigan, CRNP; David Miller, MBA; Caitlin O’Neill, DNP, RN, OCN, NEA-BC; Collen Kucharzcuk, DNP, CRNP; Roy Rosin, MBA; Edward Stadtmauer, MD; Lynn Schuchter, MD; Larry Shulman, MD; Grace Shyu, CRNP; Robert Tobin, BSN, RN, OCN; Elizabeth M. Umbro, CRNP; Christine Usher, MSN, RN, OCN; Matt Van Der Tuyn, MA; Lindsey Zinck; PhD, RN, OCN, NEA-BC
PARTNERS
Division of Hematology-Oncology; Abramson Cancer Center; Center for Health Care Innovation; Inpatient Oncology Services