title: Transition toward a nurse practitioner-managed clinic.
abstract: OBJECTIVE
  Advanced practice nurses (APNs) have been shown to provide effective quality healthcare when treating dyslipidemia, diabetes, and hypertension. As these conditions become more prevalent, APNs are becoming more widely used and respected and are a cost-effective alternative to physician-based healthcare. The Cleveland Clinic Preventive Cardiology and Rehabilitation program has progressed toward an APN-managed clinic for the past 5 years.
  
  
  METHODS
  From 1987 to 1994, the clinic was traditionally a physician-based model. In 1995, physician extenders became part of the practice. In 2002, the transition began toward an APN clinic. An initial change included continuity with one APN when scheduling follow-up visits, triaging telephone contacts, and giving prescriptions. Documentation was changed to include the APN. Policy was revised to allow "incident to" and independent billing to address revenue and accessibility issues. Schedules reflected APNs as providers. Algorithms were developed and revised jointly between APNs and physicians.
  
  
  RESULTS
  Patients have verbalized satisfaction with APN care. Survey data over a 12-month period indicated that in 5 of 8 questions pertaining to provider care, percent excellent or very good scores were 83% to 96% using a Likert scale. In the remaining 3 questions, scores ranged from 84% to 94% for the "yes, definitely" response, which was the most favorable response. Total APN visits for May 1, 2006, to May 1, 2007, were 2,522, billed independently, providing $476,031 in charges. Outcomes data for primary and secondary prevention patients showed an average improvement in the following laboratory results: 48 mg/dL total cholesterol, 36 mg/dL low-density lipoprotein, 3.5 mg/dL high-density lipoprotein, 99 mg/dL triglycerides, 3.68 mg/L ultra sensitive C-reactive protein.
  
  
  CONCLUSIONS
  APNs are an effective and efficient way to provide cardiovascular risk reduction with an emphasis on medical management, lifestyle habits, and patient education.
authors.affiliation: Preventive Cardiology and Rehabilitation and Women's Cardiovascular Center, Cleveland Clinic, Ohio, USA. gambink@ccf.org
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Gambino
authors.forename: Loretta
authors.initials: L
authors.lastname: Planavsky
authors.forename: Heather
authors.initials: H
authors.lastname: Gaudette
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000451:nursing* / Q000517:prevention & control*; D003266:Continuity of Patient Care; D003363:Cost Control; D006284:Health Plan Implementation; D006801:Humans; D017146:Models, Organizational; D009722:Nurse Practitioners; D009820:Ohio; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D000078329:Workforce