A model of care redesign within rheumatology: A mixed methods approach integrating nurse practitioners and physician assistants.

Abstract

Background: Increasing patient demand and clinician burnout in rheumatology practices have highlighted the need for more efficient models of care (MOC). Interprofessional collaboration is essential for improving patient outcomes and clinician satisfaction.

Local problem: Our current MOC lacks standardization and formal integration of Nurse Practitioners (NPs) and Physician Assistants (PAs), resulting in reduced clinician satisfaction and limited patient access. To optimize care quality, clinician satisfaction, and patient access, we sought to develop an interprofessional MOC tailored to an academic rheumatology practice.

Methods: We used a mixed methods sequential-exploratory design within a quality improvement (QI) framework to create a blueprint for MOC redesign.

Intervention: Intervention development proceeded in four phases: needs assessment, data collection, socializing key ideas, and team design and planning.

Results: In the needs assessment phase, divisional leadership was interviewed to identify shared goals for an optimized MOC. Data collection included surveys distributed to 12 physicians and 8 NPs/PAs, addressing 11 key domains related to current and future MOC needs. In phase 3, we communicated key findings to divisional leadership, clinicians, and staff. Phase 4 involved iterative team building and MOC design. Survey results revealed low satisfaction with the current MOC and a strong preference for parallel practice, standardization, and formal NP/Physician Assistant integration. Several barriers to MOC implementation were also identified.

Conclusion: Redesigning the MOC in rheumatology requires aligning clinician, leadership, and organizational priorities. A mixed methods QI approach effectively uncovers clinical needs and potential barriers, supporting the successful implementation of a new MOC.