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Direct Cost Savings Analysis of Nurse Practitioner for Inpatient Urology Practice

机译：住院医生对住院性泌尿外科实践的直接成本节约分析

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Introduction: A 2015 survey of members of the American Urological Association found the majority of urologists (62.7%) work with an advanced practice provider. The aim of this study was to analyze direct cost savings of inpatient advanced practice provider hiring focusing on direct cost, length of stay, readmission rate and discharge planning.Methods: Data from a single tertiary care referral center was collected between 2015 Q (quarter) 1 to 2018 Q2. Seven quarters before inpatient advanced practice provider implementation (2015 Ql to 2016 Q3) were compared to 7 subsequent quarters after initiation of inpatient nurse practitioner program (2016 Q4 to 2018 Q2). A total of 1,190 major urological cases were performed during this time (178 cystectomies, 663 nephrectomies, 349 prostatectomies). Factors influenced by inpatient advanced practice provider such as length of stay, discharge before 11 a.m. and total direct cost were analyzed before advanced practice provider and after advanced practice provider. Mann-Whitney U and chi-square tests were used for continuous and categorical data, respectively.Results: Advanced practice provider inclusion as part of a urology health care team showed an overall decreased length of stay (p=0.042) with an increase in discharges before 11 a.ra (p <0.001). There was no significant change in direct cost (p=0.89) combined for all 3 groups, but direct cost in the cystectomy group was significantly lower (p=0.048). There was a statistically significant improvement in discharge time for nephrectomy (p=0.039) and cystectomy (p=0.02) after advanced practice provider program initiation.Conclusions: Inclusion of an advanced practice provider within inpatient setting was shown to consistently improve length of stay and direct cost for cystectomy care.
机译：导言：2015年对美国泌尿学协会成员进行的一项调查发现，大多数泌尿科医生（62.7%）与高级实践提供者合作。本研究的目的是分析住院高级实践提供者雇佣的直接成本节约，重点是直接成本、住院时间、再入院率和出院计划。方法：从一个三级医疗转诊中心收集2015年第1季度至2018年第2季度的数据。将住院患者高级实践提供者实施前的七个季度（2015年第四季度至2016年第三季度）与启动住院患者护理从业者计划后的七个季度（2016年第四季度至2018年第二季度）进行比较。在此期间，共进行了1190例主要泌尿外科手术（178例膀胱切除术、663例肾切除术、349例前列腺切除术）。在高级实践提供者之前和高级实践提供者之后，分析了受住院高级实践提供者影响的因素，如住院时间、上午11点之前出院和总直接成本。Mann-Whitney U和卡方检验分别用于连续数据和分类数据。结果：作为泌尿科医疗团队的一部分，高级实践提供者的总体住院时间缩短（p=0.042），11岁前出院人数增加（p<0.001）。所有3组的直接费用（p=0.89）组合没有显著变化，但膀胱切除组的直接费用显著降低（p=0.048）。在高级实践提供者项目启动后，肾切除术（p=0.039）和膀胱切除术（p=0.02）的出院时间在统计学上有显著改善。结论：在住院患者中加入先进的实践提供者，可以持续改善膀胱切除术治疗的住院时间和直接成本。

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