title: Improving Access to Head and Neck Cancer Surgical Services through the Incorporation of Associate Providers.
abstract: The urgent nature of head and neck cancer referrals often results in overbooked schedules, access delays, and patient, physician, and staff dissatisfaction. The goal of this study is to examine how incorporation of associate providers (APs) into a head and neck tumor clinic (HNTC) can improve access.
  
  
  
  Scheduling data for the Dartmouth-Hitchcock HNTC 2 years prior (January 2011 to December 2012) and 2 years subsequent (January 2013 to December 2014) to program initiation were abstracted, including number of new patients seen per month, third available for new and established patients, overbooked hours, surgeon productivity, and patient satisfaction scores.
  
  
  
  New patients seen per month increased from 44 ± 4 to 60 ± 5 (P < .001). Third available for new patients decreased from 56 ± 4 to 27 ± 2 days and from 43 ± 3 to 35 ± 2 days for follow-ups (P < .001). Overbooked hours decreased from 14.7 ± 3.1 to 8.6 ± 1.7 hours (P < .001). Surgeon productivity remained stable (109% ± 11% vs 113% ± 6%, P = .56). Patient satisfaction in seeing APs versus surgeons was comparable (94 ± 2 vs 94 ± 3, P = .79).
  
  
  
  Incorporation of APs into the HNTC increases the number of new patients seen by the surgeon, decreases wait times for all appointments, and decreases overbooking while maintaining patient satisfaction and surgeon productivity.
  
  
  
  AP incorporation significantly improves access to head and neck surgical services. With improved access, new cancer patients could start treatment sooner, potentially affecting outcome.
authors.affiliation: Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA joseph.paydarfar@hitchcock.org.|Norris Cotton Cancer Center, Lebanon, New Hampshire, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Paydarfar
authors.affiliation: Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.|Norris Cotton Cancer Center, Lebanon, New Hampshire, USA.
authors.forename: Benoit J
authors.initials: BJ
authors.lastname: Gosselin
authors.affiliation: Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Tietz
mesh_terms: D001071:Appointments and Schedules; D004526:Efficiency; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008495:Medical Oncology; D017060:Patient Satisfaction; D010823:Physician Assistants; D010865:Pilot Projects; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014850:Waiting Lists; D000078329:Workforce
keywords: access; associate provider; head and neck cancer; head and neck surgery