Optimizing New Urogynecology Consultations: Advanced Practice Providers are Key

Abstract

Objective: Advanced practice providers (APPs) are commonplace in urogynecology, but there is a lack of research evaluating their integration into outpatient care. This study evaluated an outpatient model wherein APPs functioned as new patient consultants. To evaluate feasibility, we determined the concordance (agreement) between the APP's recommended plan for operative intervention at initial consultation and the surgeon's plan at subsequent consultation hypothesizing ≥ 90% concordance.

Design: Prospective, feasibility study.

Setting: Single institution in an urban outpatient urogynecology setting.

Participants: Women ≥ 18 years seeking new urogynecology consultation.

Interventions: Patients who received a recommended care plan from the APP that included an operative intervention were subsequently scheduled for a consultation with a surgeon. The primary outcome was concordance for operative intervention by the APP and surgeon. Secondary outcomes included concordance of specific operative approach, wait time to initial consultation, and patient satisfaction. A confidence interval approach was used to estimate a sample size of 100 participants, a priori.

Results: In a sample of 100 patients, the concordance between the APP and surgeon for operative intervention was 95% (one-sided 95% CI = 0.90 - 1.00). For 29 of 30 treatment plans that included a specific operative approach, concordance was 97% (95% CI = 0.85 - 1.00). Median time to initial consultation was 49 days (IQR 40 - 77). Eighty-one percent of women completed patient satisfaction surveys and reported high satisfaction with the initial APP consultation.

Conclusion: For women undergoing new urogynecology consultation, high concordance of 95% between the APP and surgeon suggests this model can be feasible. This outpatient model, which allowed APPs to function as new patient consultants, provided a practical approach to address our growing need for urogynecology care.

Keywords: advanced practice provider; concordance; outpatient care model; patient satisfaction; urogynecology.