1. Update from the National Marrow Donor Program 2013 Hematopoietic Stem Cell Transplant Advanced Practice Providers Conference Eneida R. Nemecek, MD, MBA September 12, 2013 Financial Disclosure – None Speaker is a member of the NMDP Board of Directors

2. System Capacity Initiative Description Analysis of the U.S. health care system’s capacity to support a 2- to 3-fold increase in patients needing transplant by 2020* System Capacity Initiative - Collaboration by representatives of all stakeholders of HCT - Recommendations and solutions for issues affecting the delivery of HCT * Analysis by NMDP and CIBMTR estimates a need of 10,000 transplants based on current indications in patients up to age 60. 2 2

3. Transplants Transplant Activity in the U.S. 1980-2010 Pasquini MC, Wang Z. Current use and outcome of hematopoietic stem cell transplantation: CIBMTR Summary Slides, 2011.

4. NMDP Transplants Facilitated to Date 4 4 Number of Transplants

5. The Need By applying the optimal transplant rate to the U.S. population, the need for allogeneic (related and unrelated) transplant is 18,000 per year. –Related – 5,500 per year –Unrelated – 12,500 per year 5. 5

6. 6 Population Growth: 2000 to 2020 U.S. Census Bureau

7. 7 Increasing indications and increasing age

8. Improved survival of older allogeneic HCT recipients Kurosawa et al. BBMT 2011, 17:401-411 8

9. 9 The call for a diverse workforce

10. 10 Goals of SCI Assess current system capacity challenges and make recommendations to support growth: Define and prioritize initiatives to meet human resource and infrastructure demands - Number and type of clinicians - Facility capacity - Financial support needed Explore novel models for delivery of care to improve efficiency and effectiveness Identify capacity issues that may limit access to HCT for diverse and underserved populations 10

11. System Capacity Initiative Program Organization and Participants 11

12. Professional Organizations and Stakeholder Engagement 12

13. System Capacity Initiative Program Schema 13 Year 4: A Workforce Summit is being planned for Tuesday, November 19, 2013.

14. Common Findings from Workforce Groups Inadequate number of providers Lack of awareness among those in training of transplant as a career option –Reduction over time of exposure to transplant as training priorities change and the complexity of transplant care increases Large variation in the membership and use of the care team between centers –Lack of benchmarks on effective and efficient use of workforce 14

15. Common Recommendations Early exposure to transplant in training –Clinicians and researchers should convey the positive aspects of the profession to trainees Diverse exposure to outpatient as well as inpatient care Optimal use of each professional group on the multidisciplinary transplant team Promoting the multi-disciplinary nature of the transplant team 15

16. Common Recommendations Retention issues –Compensation/benefits/burnout/compassion fatigue –Work/life balance Efficiency/effectiveness –Use of benchmarks to assess work effort to compare to other centers and other specialties 16

17. Advanced Practice Professionals 17

18. NMDP – NP/PA SCI Working Group Monthly conference calls SCI Steering Committee and Working Groups met annually at 1½ day symposia to present and evaluate recommendations from each group –Symposium 1 – Chicago 2010 –Symposium 2 – Minneapolis 2011 –Symposium 3 – Minneapolis 2012 –Symposium 4 – Minneapolis 2013 (Nov 19) To view presentations, more information: http://marrow.org/HD/SCI/SCI_Symposia.aspx 18

19. NMDP – NP/PA SCI WG Year 1 Summary Survey Pilot in NP/PA school Needs assessment of NP/PA – 2011 Tandem Began to assemble smaller working groups 19

20. Year 1 Survey 224 NP/PA (45% response rate) 20

21. Year 1 NP/PA NMDP WG Survey Highlights Data Highlights –Full time  97% work more than 40 hrs per week –74% have less than 10% non-clinical time research, committee, education, administrative –69% of NP/PA schools have no HemOnc/BMT course –48% NP/PA transferred from other positions to HCT 21

22. Year 1 NP/PA NMDP WG Survey Highlights Job satisfaction & retention –41% will/might reduce hours –30% will/think of changing jobs –24% are thinking about a career change 79% feel BMT MDs are interested in having them perform higher roles in patient care, and that they are not working to top of their license 22

23. Year 1 NP/PA NMDP WG Survey Highlights 23

24. Year 1 NP/PA NMDP WG Survey Highlights Top most satisfying aspect of working in HCT –Intellectual stimulation of patient care –Emotional gratification of patient care –Intellectual stimulation of research/new discovery Top least satisfying aspect of position –Job related stress/work demands –Burn out related to sick and dying patients –Excessive work hours –Insufficient salary 24 Both mirror MD survey responses

25. Year 1 NP/PA - Needs assessment at Tandem 2011 Needs assessment completed for NPs/PAs at Tandem –70% of attendees at Tandem were interested in opportunities for NPs/PAs to network outside of their own institution –100% felt the profession would benefit from creating a national HCT SIG through ASBMT 25

26. Year 1 Education Pilot NP/PA schools HCT 101 Lecture in NP/PA schools –1 st and 2 nd year students received HCT 101 lecture –Students were surveyed prior and post lecture Regardless of year in schooling, were more likely to pursue a career in HCT after the lecture –Impact greater on first year students –Generated interest in shadowing or clinical rotations 26

27. NMDP NP/PA - Year 2 Summary Sub-groups formed within NMDP NP/PA WG to address following needs: –Education –Compensation/benefits –Collaboration with NMDP and other groups –Defining the role of NP/PA in HCT –Work models for NPs/PAs 27

28. Optimal Work Model and Role Definition Documents Designed to support: Current NPs/PAs in HCT practice NP/PA students interested in a career Recruitment of currently practicing PAs/NPs HCT MDs, program directors and administrators in the utilization of NPs/PAs 28

29. Recommendations for Optimal Work Models for Physician Assistants and Nurse Practitioners Working in Hematopoietic Cell Transplantation Recommendations on: Work hours / schedule Multidisciplinary support staff Patient care models Salary / compensation Professional development and support 29

30. Role of the Physician Assistant/Nurse Practitioner in Stem Cell Transplantation Provide quality care to BMT patients in conjunction with the patient’s physician and care team under the guidelines established by their institutions, ASBMT, NMDP and current best practices in medicine 30

31. Care Delivery – NP/PA’s Outpatient Role 31 1-35 HCT N=18 36-75 HCT N=18 76-130 HCT N=17 131-190 HCT N=14 >190 HCT N=18 Center Size (HCT/year) No NP/PA’s in outpatient clinic See patients independently See patients and staff with MD NP/PA’s role in outpatient clinic, % Courtesy of Dr. Navneet Majhail ???

32. Advanced Practice Professionals Top Initiatives Creation and structuring of a more in-depth ASBMT APP Steering Committee organizational structure Dedicated web page for APPs through the ASBMT website; identifying, defining and developing content for the site Continuing outreach to students and APPs working in other fields, to increase awareness of HCT with the intent to positively impact recruitment and retention 32

33. Expand the ASBMT APP Steering Committee 33 Created 4 new working groups 1.Education 2.Research 3.Website development 4.Liaison positions APAO APHON ONS

34. ASBMT NP/PA Org Structure 34 ONS - Oncology Nursing Society APAO - Association of PAs in Oncology APHON - Association of Pediatric Hematology/Oncology Nursing

35. Development of a webpage for APPs Content development in process in the following areas: 1.Education APP guidelines, HCT 101, ASBMT COE PIMs, etc. 2.Students/careers Job search, student rotations, link to graduate programs, APP role in HCT document, links to education 3.Employer focused Work model recommendations, discussion forum 4.APP - Who we are 5.Discussion/Forum Bi-annual newsletter, professional practice issues, blogs, etc. 6.Membership 7.Research opportunities 35

36. Educational Outreach Current Collaborating with ASBMT Committee on Education (COE) –NP/PA Training Guidelines, Tandem Meeting Tandem 2013 – first NP/PA abstract session –Research working group formed (QI and clinical projects) HCT 101 Lecture Video – Dr. Cutler Website development and links within ASBMT/NMDP –NMDP Clinical Lecture Series Future Educational efforts with APAO, ONS and APHON partnership NP/PA school collaboration for teaching Brochure to NP/PA schools with access to HCT 101/other lectures Clinical rotations – learn from existing and create more Consider regional conferences and educational opportunities outside BMT Tandem Meetings 36

37. Training Guidelines American Society of Blood and Marrow Transplantation (ASBMT): Guidelines for Training in Hematopoietic Progenitor Cell Transplantation for Nurse Practitioners and Physician Assistants (NPs/PAs) 37

38. Collaborations –internal and external Formal liaison positions created with national NP/PA organizations –Oncology Nursing Society (ONS) –Association of PAs in Oncology (APAO) –Association of Pediatric Hematology/Oncology Nursing (APHON) ASBMT Committee on Education – NP/PA liaison Working Committees/Task Force – NP/PA reps 38

39. Challenges We need your help –Join the efforts of the working group Mentoring SIG Committees Education: Penetrate NP/PA schools early Engage multidisciplinary learners We need more data –Participate in surveys –Defining optimal work models and how to support changes in practice so NPs/PAs can work at “top of license” We can create demand….are centers ready to increase supply? –BMT supply/demand and ACGME regulatory changes –Facility constraints

40. What can you do? Join ASBMT if you are not a member –182 NPs/PAs registered at Tandem 2013 –49 NP/PA SIG members total Volunteer to join a working group Help spread the word to your colleagues 40

41. NMDP SCI Working Group Members Members –Susan M. Burroughs, PA-C –Gilbert Ciocci, NSN, FNP-BC –Theresa Donohue, PA –Julia Gourde, RN, CNP –Amy Joyce, MSN, ANP, AOCN –Shelly Mentzer, MMS, PA-C –Jerelyn Moffet, CPNP –Eneida Nemecek, MD, MBA –Nancy Shreve, NP, MS, FNP –Susan Slater, MN, FNP-BC –Kristin Sterling, APRN-BC –Cindy Treviño, ANP-BC, AOCN Chair –Deborah Yolin Raley, PA-C Vice Chair –Erin Medoff, APRN NMDP Lead Staff –Jason Dehn, MPH, CHTC –Megan Cooper, BS, CHTC –Joan Jarosh (admin.) Special Thanks –Paula Cuthrell NP –Colleen Brown PA –Melissa Cochran NP –Thomas Joseph ASBMT 41

42. ASBMT Steering Committee APP SIG 2013 Paula Cuthrell, CNP, CFNP, Chair Michael Wilson, PA-C, Past-Chair Susan Burroughs PA- C, Chair-elect Colleen Brown PA-C Lori Burton, MSN, CPNP William Levy, PA-C Jackie Lagerlof, MS, PA-C Ashley Miller, RN, MSN, FNP-BC, AOCNP, MPH Carina Moravec, ARNP Amy Witter, PA-C Deborah Yolin-Raley, PA-C Amy Klingler, PA-C, ex- officio 42

43. 43 Questions or Comments Email: SystemCapacity@nmdp.org