Shirley H. Lee, CRNP-FNP, MPH

Shirley H. Lee, CRNP-FNP, MPH

Torrance, California

Disclosures:

Shirley H. Lee, CRNP-FNP, MPH, is Vice President of Clinical Strategy for Preveta, a care coordination platform for specialty care. She is also the director of a patient navigation program and a nurse practitioner for the Greater Los Angeles Division of Genesis Healthcare Partners, P.C. Lee is a graduate of the Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health.

Talks by Shirley H. Lee, CRNP-FNP, MPH

Point-Counterpoint: PCR and NGS is the New Standard for Clinical Evaluation, not Culture and Sensitivity – Con

Point-Counterpoint: PCR and NGS is the New Standard for Clinical Evaluation, not Culture and Sensitivity – Con

Posted by | Nov 2023

Shirley H. Lee, CRNP-FNP, MPH, argues against polymerase chain reaction (PCR)/ next-generation sequencing (NGS) as the new standard of care for clinical evaluation of urinary tract infection (UTI), favoring culture and sensitivity instead. Lee asserts that using PCR/NGS as the new standard for evaluating UTI may lead to antibiotic overuse and points out the consequences can’t be anticipated. 

Dr. Lee explains that historically the goal was to eradicate all bacteria from the urine while today, clinicians understand that some bacteria act intracellularly while others just attach to the surface and today’s goal is to treat proven and symptomatic UTI. Lee addresses some drawbacks of culture as well as advantages and disadvantages of NGS and PCR before turning back to the issue of overtreatment. 

Dr. Lee explains that the primary goal of treatment should be the amelioration of symptoms and prevention of complications and asserts that antibiotic resistance has increased since the COVID-19 pandemic. She acknowledges there are many studies comparing PCR/NGS vs. Cultures, but points out their limitations and asserts more are needed. 

Dr. Lee enumerates key takeaways, including that PCR/NGS may not distinguish between uropathogens and normal urobiome; there is insufficient evidence as to whether data from PCR/NGS has clinical relevance; PCR/NGS may cause overuse of antibiotics with consequences that practitioners cannot fully anticipate. She asserts PCR/NGS should be limited to situations where infection is strongly suspected despite negative culture, to situations with recalcitrant infection, and to use by specialists (e.g., urology, infectious disease). Finally, Lee asserts that a test that can find more things does not equal better patient care and clinical judgment is key in treatment decision making.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: PCR and NGS is the New Standard for Clinical Evaluation, not Culture and Sensitivity – Pro.”

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Improving Outcomes and Revenue with Patient Navigation

Improving Outcomes and Revenue with Patient Navigation

Posted by | Oct 2023

Shirley H. Lee, CRNP-FNP, MPH, explains how patient navigators positively impact patient visits, prostate cancer identification, and revenue. She begins by highlighting the patient navigator’s aim to support patients throughout all aspects of their healthcare journey. She turns to the American Cancer Society to pinpoint the need for patient navigators.

She then focuses on 2022 patient navigator outcomes from Genesis Healthcare Partners. Notable outcomes included more emergency room visits averted, better identification of cancer and cancer progression, and increased patient satisfaction. She reviews a prostate cancer case study, and finds that patient navigators can collaborate with office staff and providers to coordinate care, thereby helping patients and generating $270,000 in chronic care model (CCM) revenue. She notes that patient navigators can align with CCM, as in the case of clinical staff who perform billable non-face-to-face care coordination.

She then analyzes urology group participation and eligible diagnoses. She introduces a CCM case study, examining a practice with 500 Medicare patients, and explaining how practices can financially support the work of patient navigators. Lee discusses how patient navigators can impact ancillary services. She also utilizes a prostate cancer case study to illustrate how patient navigators can guide patients through appointments and treatments. She closes with a three-step patient navigator guide tailored to prostate cancer, encouraging practitioners to implement a patient navigator system and improve patient care.

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Developing Clinical Pathways to Improve Management and Outcomes in Women’s Health

Developing Clinical Pathways to Improve Management and Outcomes in Women’s Health

Posted by | Oct 2023

Shirley H. Lee, CRNP-FNP, MPH, discusses developing clinical pathways to improve management and outcomes in women’s health, defining clinical pathways as the translation of complicated algorithms into efficient clinical workflows. Lee then explains the many treatment options for overactive bladder (OAB) for female patients, stating that 80 percent of patients are unsatisfied with their medication at six months, and asserting that clinicians must do a better job at successfully moving patients through the clinical pathway.

She then breaks the OAB clinical pathway into levels based on the invasiveness of treatment, and points out the importance of diagnostics between each of these levels in effectively tailoring treatment to individual patients. Lee explains that the clinical pathways can standardize care, leave fewer data gaps, and allow for earlier detection of treatment efficacy.

She then delves into a case study to illustrate the importance of a guided survey chart review whereby the navigator conducts an OAB symptom survey, instructs the patient on a voiding diary, and discusses OAB treatment options and follow-up. Lee explains the steps involved in executing clinical pathways for female patients, including establishing patient outcomes, ensuring that care pathways align with goals for those patient outcomes, and streamlining the workflow for all involved.

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