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Hematology and Oncology Staffing Levels for Fiscal Years 19–24
Background
Department of Veterans Affairs (VA) faces a landscape of increasingly complex practice, especially in Hematology/Oncology (H/O), and a nationwide shortage of healthcare providers, while serving more Veterans than ever before. To understand current and future staffing needs, the VA National Oncology Program performed an assessment of H/O staffing, including attending physicians, residents/ fellows, licensed independent practitioners (LIPs) (nurse practitioners/physician assistants), and nurses for fiscal years (FY) 19–24.
Methods
Using VA Corporate Data Warehouse, we identified H/O visits in VA from 10/01/2018 through 09/30/2024 using stop codes. No-show (< 0.00001%) and National TeleOncology appointments (1%) were removed. We retrieved all notes associated with resulting visits and used area-ofspecialization and provider-type data to identify all attending physicians, trainees, LIPs, and nurses who authored or cosigned these notes. We identified H/O staff as 1. those associated with H/O clinic locations, 2. physicians who consistently cosigned H/O notes authored by fellows and LIPs associated with H/O locations, 3. fellows and LIPs authoring notes that were then cosigned by H/O physicians, and 4. nurses authoring notes associated with H/O visits.
Analysis
For each FY, we obtained total numbers of visits, unique patients, and care-providing staff by type. For validation, collaborating providers at several sites reviewed visit information, and a colleague also performed an independent, parallel data extraction. We adjusted FY totals to account for the growing patient population by dividing unique staff count by number of unique patients and multiplying by 200,000 (the approximate number of unique patients in FY19).
Results
From FY19 through FY24, VA Hematology/ Oncology saw a 14.6% rise in unique patients (from 232,084 to 265,926) and a 15.4% rise in visits (from 923,175 to 1,065,186). The absolute number of attendings rose by 4 (0.6%); of LIPs, by 138 (14.4%); and of nurses, by 142 (4.9%); trainees fell by 102 (4.3%). Adjusted to 200,000 patients, the number of attendings fell by 76 (12.3%); LIPs, by 1 (0.1%); trainees, by 335 (16.5%); and nurses, by 211 (8.4%).
Conclusions
Adjusted to number of Veterans, there are 10.4% fewer staff in Hematology/Oncology in FY24 compared to FY19.
Background
Department of Veterans Affairs (VA) faces a landscape of increasingly complex practice, especially in Hematology/Oncology (H/O), and a nationwide shortage of healthcare providers, while serving more Veterans than ever before. To understand current and future staffing needs, the VA National Oncology Program performed an assessment of H/O staffing, including attending physicians, residents/ fellows, licensed independent practitioners (LIPs) (nurse practitioners/physician assistants), and nurses for fiscal years (FY) 19–24.
Methods
Using VA Corporate Data Warehouse, we identified H/O visits in VA from 10/01/2018 through 09/30/2024 using stop codes. No-show (< 0.00001%) and National TeleOncology appointments (1%) were removed. We retrieved all notes associated with resulting visits and used area-ofspecialization and provider-type data to identify all attending physicians, trainees, LIPs, and nurses who authored or cosigned these notes. We identified H/O staff as 1. those associated with H/O clinic locations, 2. physicians who consistently cosigned H/O notes authored by fellows and LIPs associated with H/O locations, 3. fellows and LIPs authoring notes that were then cosigned by H/O physicians, and 4. nurses authoring notes associated with H/O visits.
Analysis
For each FY, we obtained total numbers of visits, unique patients, and care-providing staff by type. For validation, collaborating providers at several sites reviewed visit information, and a colleague also performed an independent, parallel data extraction. We adjusted FY totals to account for the growing patient population by dividing unique staff count by number of unique patients and multiplying by 200,000 (the approximate number of unique patients in FY19).
Results
From FY19 through FY24, VA Hematology/ Oncology saw a 14.6% rise in unique patients (from 232,084 to 265,926) and a 15.4% rise in visits (from 923,175 to 1,065,186). The absolute number of attendings rose by 4 (0.6%); of LIPs, by 138 (14.4%); and of nurses, by 142 (4.9%); trainees fell by 102 (4.3%). Adjusted to 200,000 patients, the number of attendings fell by 76 (12.3%); LIPs, by 1 (0.1%); trainees, by 335 (16.5%); and nurses, by 211 (8.4%).
Conclusions
Adjusted to number of Veterans, there are 10.4% fewer staff in Hematology/Oncology in FY24 compared to FY19.
Background
Department of Veterans Affairs (VA) faces a landscape of increasingly complex practice, especially in Hematology/Oncology (H/O), and a nationwide shortage of healthcare providers, while serving more Veterans than ever before. To understand current and future staffing needs, the VA National Oncology Program performed an assessment of H/O staffing, including attending physicians, residents/ fellows, licensed independent practitioners (LIPs) (nurse practitioners/physician assistants), and nurses for fiscal years (FY) 19–24.
Methods
Using VA Corporate Data Warehouse, we identified H/O visits in VA from 10/01/2018 through 09/30/2024 using stop codes. No-show (< 0.00001%) and National TeleOncology appointments (1%) were removed. We retrieved all notes associated with resulting visits and used area-ofspecialization and provider-type data to identify all attending physicians, trainees, LIPs, and nurses who authored or cosigned these notes. We identified H/O staff as 1. those associated with H/O clinic locations, 2. physicians who consistently cosigned H/O notes authored by fellows and LIPs associated with H/O locations, 3. fellows and LIPs authoring notes that were then cosigned by H/O physicians, and 4. nurses authoring notes associated with H/O visits.
Analysis
For each FY, we obtained total numbers of visits, unique patients, and care-providing staff by type. For validation, collaborating providers at several sites reviewed visit information, and a colleague also performed an independent, parallel data extraction. We adjusted FY totals to account for the growing patient population by dividing unique staff count by number of unique patients and multiplying by 200,000 (the approximate number of unique patients in FY19).
Results
From FY19 through FY24, VA Hematology/ Oncology saw a 14.6% rise in unique patients (from 232,084 to 265,926) and a 15.4% rise in visits (from 923,175 to 1,065,186). The absolute number of attendings rose by 4 (0.6%); of LIPs, by 138 (14.4%); and of nurses, by 142 (4.9%); trainees fell by 102 (4.3%). Adjusted to 200,000 patients, the number of attendings fell by 76 (12.3%); LIPs, by 1 (0.1%); trainees, by 335 (16.5%); and nurses, by 211 (8.4%).
Conclusions
Adjusted to number of Veterans, there are 10.4% fewer staff in Hematology/Oncology in FY24 compared to FY19.
Data Elements Captured in Breast and Gynecologic Oncology System of Excellence Health Informatics Tool
Background
The VA National Oncology Program (NOP) Breast and Gynecologic Oncology System of Excellence (BGSOE) aims to ensure that Veterans with breast and gynecologic cancers receive state-of-the-art, guidelineadherent, Veteran-centric, timely, and well-coordinated care. Achieving these aims relies on a national multidisciplinary Cancer Care Navigation Team that provides tele-oncology navigation services. The teams connect with Veterans to identify and support clinical, psychological, system, coordination-related needs. To assist the navigation team to find these relatively rare diagnoses within VA, we developed a health informatics tool (HIT) that automatically identifies patients with breast or gynecologic cancers, displays demographic and clinical information, and facilitates systematic needs assessment and care coordination and tracking.
Methods
We used multiple frameworks to ensure alignment between HIT mission and coordinator workflow. A separate view was provided for each phase of the workflow: assessment of Veteran eligibility, intake assessment, and care coordination and tracking. Algorithmic identification of candidate Veterans was validated to ensure coordinators were not inundated with information on Veterans outside the scope of the program. User interface was implemented in accordance with Lean principles applied to HIT design, with close attention to information inventory, efficient user motion, information transportation, and avoidance of overprocessing.
Results
From January 1, 2021, to March 6, 2024, the HIT captured 5,561 breast cancer and 1,663 gynecologic cancer patients. 908 patients were reviewed by the coordinator, of whom 817 patients had a correct diagnosis assigned by the screening algorithm. From these, 332 patients were added to the intake process. The intake process is pending for 207 patients and complete for 102 patients; 23 patients declined intake. For patients who have completed intake, we have captured information that includes Veteran demographics, social history, insurance details, medical history, family history, hazards, barriers, and information specific to BGSOE care coordination.
Conclusions
We applied a novel framework to design and implement mission-driven, workflow-aligned HIT that achieves high user efficiency using Lean principles. This facilitated an exciting new model in tele-oncology care navigation delivery. Although the program is still in early phases, it has improved care coordination for Veterans with breast and gynecologic cancers across the United States.
Background
The VA National Oncology Program (NOP) Breast and Gynecologic Oncology System of Excellence (BGSOE) aims to ensure that Veterans with breast and gynecologic cancers receive state-of-the-art, guidelineadherent, Veteran-centric, timely, and well-coordinated care. Achieving these aims relies on a national multidisciplinary Cancer Care Navigation Team that provides tele-oncology navigation services. The teams connect with Veterans to identify and support clinical, psychological, system, coordination-related needs. To assist the navigation team to find these relatively rare diagnoses within VA, we developed a health informatics tool (HIT) that automatically identifies patients with breast or gynecologic cancers, displays demographic and clinical information, and facilitates systematic needs assessment and care coordination and tracking.
Methods
We used multiple frameworks to ensure alignment between HIT mission and coordinator workflow. A separate view was provided for each phase of the workflow: assessment of Veteran eligibility, intake assessment, and care coordination and tracking. Algorithmic identification of candidate Veterans was validated to ensure coordinators were not inundated with information on Veterans outside the scope of the program. User interface was implemented in accordance with Lean principles applied to HIT design, with close attention to information inventory, efficient user motion, information transportation, and avoidance of overprocessing.
Results
From January 1, 2021, to March 6, 2024, the HIT captured 5,561 breast cancer and 1,663 gynecologic cancer patients. 908 patients were reviewed by the coordinator, of whom 817 patients had a correct diagnosis assigned by the screening algorithm. From these, 332 patients were added to the intake process. The intake process is pending for 207 patients and complete for 102 patients; 23 patients declined intake. For patients who have completed intake, we have captured information that includes Veteran demographics, social history, insurance details, medical history, family history, hazards, barriers, and information specific to BGSOE care coordination.
Conclusions
We applied a novel framework to design and implement mission-driven, workflow-aligned HIT that achieves high user efficiency using Lean principles. This facilitated an exciting new model in tele-oncology care navigation delivery. Although the program is still in early phases, it has improved care coordination for Veterans with breast and gynecologic cancers across the United States.
Background
The VA National Oncology Program (NOP) Breast and Gynecologic Oncology System of Excellence (BGSOE) aims to ensure that Veterans with breast and gynecologic cancers receive state-of-the-art, guidelineadherent, Veteran-centric, timely, and well-coordinated care. Achieving these aims relies on a national multidisciplinary Cancer Care Navigation Team that provides tele-oncology navigation services. The teams connect with Veterans to identify and support clinical, psychological, system, coordination-related needs. To assist the navigation team to find these relatively rare diagnoses within VA, we developed a health informatics tool (HIT) that automatically identifies patients with breast or gynecologic cancers, displays demographic and clinical information, and facilitates systematic needs assessment and care coordination and tracking.
Methods
We used multiple frameworks to ensure alignment between HIT mission and coordinator workflow. A separate view was provided for each phase of the workflow: assessment of Veteran eligibility, intake assessment, and care coordination and tracking. Algorithmic identification of candidate Veterans was validated to ensure coordinators were not inundated with information on Veterans outside the scope of the program. User interface was implemented in accordance with Lean principles applied to HIT design, with close attention to information inventory, efficient user motion, information transportation, and avoidance of overprocessing.
Results
From January 1, 2021, to March 6, 2024, the HIT captured 5,561 breast cancer and 1,663 gynecologic cancer patients. 908 patients were reviewed by the coordinator, of whom 817 patients had a correct diagnosis assigned by the screening algorithm. From these, 332 patients were added to the intake process. The intake process is pending for 207 patients and complete for 102 patients; 23 patients declined intake. For patients who have completed intake, we have captured information that includes Veteran demographics, social history, insurance details, medical history, family history, hazards, barriers, and information specific to BGSOE care coordination.
Conclusions
We applied a novel framework to design and implement mission-driven, workflow-aligned HIT that achieves high user efficiency using Lean principles. This facilitated an exciting new model in tele-oncology care navigation delivery. Although the program is still in early phases, it has improved care coordination for Veterans with breast and gynecologic cancers across the United States.
National Tele-Oncology High-Risk Breast Clinic Program
Background
Assess implementation outcomes of the National Tele-Oncology’s first high-risk breast clinic program, part of the Breast and Gynecological System of Excellence (BGSOE). Women Veterans are the fastest-growing demographic in the Veteran population. Breast cancer (BC) is the most prevalent cancer among women. An estimated 15% of women will be considered high risk for BC at some point during their lifetime. For these reasons, the BGSOE high-risk breast clinic offers screening and risk reduction care to women with an increased risk for BC.
Methods
We described the patients seen in the BGSOE high-risk breast clinic since its implementation in 2023. We collected demographic and geographic information, genetic testing status, imaging, and risk-reducing agents (RRA) use. We reported percentages for categorical variables, followed by the total number of patients in parenthesis.
Results
There are a total of 124 patients served since 2023 (123 female, 1 male). The average age was 44.6 years. 61.3% (76) of patients lived in an urban setting, while 38.7% (48) lived in rural areas. Most patients were White at 63.7% (79), followed by African American 20.2%(25), Other 5.6% (7), and Unknown/declined 10.5%(13). Regarding ethnicity, 9% (12) were Hispanic. The most common reasons for referral to the clinic were a family history of breast cancer 89.2% (111), followed by high-risk genetic pathogenic variants 5.6% (7), mammary dysplasia 3.2% (4), inconclusive imaging 0.8% (1) and personal history of radiation 0.8%(1). 2 patients were started on RRAs. 56% (70) of patients had genetic testing discussions. The clinic coordinated 50 mammograms and 10 breast MRIs.
Conclusions
We demonstrated the successful implementation of the BGSOE high-risk breast program. We reached multiple historically underserved populations, including a high percentage of rural and African American patients. We also facilitated breast MRIs. Similar to other studies, there was a low uptake of RRA in our clinic. BGSOE is now working on a clinical pathway to standardize RRA and breast imaging recommendations for high-risk women. There are many more women Veterans at risk for BC and future expansion of the highrisk breast clinic could further raise awareness of lifetime breast cancer risk and risk-reducing and surveillance options in Veterans.
Background
Assess implementation outcomes of the National Tele-Oncology’s first high-risk breast clinic program, part of the Breast and Gynecological System of Excellence (BGSOE). Women Veterans are the fastest-growing demographic in the Veteran population. Breast cancer (BC) is the most prevalent cancer among women. An estimated 15% of women will be considered high risk for BC at some point during their lifetime. For these reasons, the BGSOE high-risk breast clinic offers screening and risk reduction care to women with an increased risk for BC.
Methods
We described the patients seen in the BGSOE high-risk breast clinic since its implementation in 2023. We collected demographic and geographic information, genetic testing status, imaging, and risk-reducing agents (RRA) use. We reported percentages for categorical variables, followed by the total number of patients in parenthesis.
Results
There are a total of 124 patients served since 2023 (123 female, 1 male). The average age was 44.6 years. 61.3% (76) of patients lived in an urban setting, while 38.7% (48) lived in rural areas. Most patients were White at 63.7% (79), followed by African American 20.2%(25), Other 5.6% (7), and Unknown/declined 10.5%(13). Regarding ethnicity, 9% (12) were Hispanic. The most common reasons for referral to the clinic were a family history of breast cancer 89.2% (111), followed by high-risk genetic pathogenic variants 5.6% (7), mammary dysplasia 3.2% (4), inconclusive imaging 0.8% (1) and personal history of radiation 0.8%(1). 2 patients were started on RRAs. 56% (70) of patients had genetic testing discussions. The clinic coordinated 50 mammograms and 10 breast MRIs.
Conclusions
We demonstrated the successful implementation of the BGSOE high-risk breast program. We reached multiple historically underserved populations, including a high percentage of rural and African American patients. We also facilitated breast MRIs. Similar to other studies, there was a low uptake of RRA in our clinic. BGSOE is now working on a clinical pathway to standardize RRA and breast imaging recommendations for high-risk women. There are many more women Veterans at risk for BC and future expansion of the highrisk breast clinic could further raise awareness of lifetime breast cancer risk and risk-reducing and surveillance options in Veterans.
Background
Assess implementation outcomes of the National Tele-Oncology’s first high-risk breast clinic program, part of the Breast and Gynecological System of Excellence (BGSOE). Women Veterans are the fastest-growing demographic in the Veteran population. Breast cancer (BC) is the most prevalent cancer among women. An estimated 15% of women will be considered high risk for BC at some point during their lifetime. For these reasons, the BGSOE high-risk breast clinic offers screening and risk reduction care to women with an increased risk for BC.
Methods
We described the patients seen in the BGSOE high-risk breast clinic since its implementation in 2023. We collected demographic and geographic information, genetic testing status, imaging, and risk-reducing agents (RRA) use. We reported percentages for categorical variables, followed by the total number of patients in parenthesis.
Results
There are a total of 124 patients served since 2023 (123 female, 1 male). The average age was 44.6 years. 61.3% (76) of patients lived in an urban setting, while 38.7% (48) lived in rural areas. Most patients were White at 63.7% (79), followed by African American 20.2%(25), Other 5.6% (7), and Unknown/declined 10.5%(13). Regarding ethnicity, 9% (12) were Hispanic. The most common reasons for referral to the clinic were a family history of breast cancer 89.2% (111), followed by high-risk genetic pathogenic variants 5.6% (7), mammary dysplasia 3.2% (4), inconclusive imaging 0.8% (1) and personal history of radiation 0.8%(1). 2 patients were started on RRAs. 56% (70) of patients had genetic testing discussions. The clinic coordinated 50 mammograms and 10 breast MRIs.
Conclusions
We demonstrated the successful implementation of the BGSOE high-risk breast program. We reached multiple historically underserved populations, including a high percentage of rural and African American patients. We also facilitated breast MRIs. Similar to other studies, there was a low uptake of RRA in our clinic. BGSOE is now working on a clinical pathway to standardize RRA and breast imaging recommendations for high-risk women. There are many more women Veterans at risk for BC and future expansion of the highrisk breast clinic could further raise awareness of lifetime breast cancer risk and risk-reducing and surveillance options in Veterans.