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Raver C, Bunker J, Caldwell M, Eldore L, Columbus C, Ogola G, Ahmed K, Au C, Schick A, Perez G. Comparison of hospitalist service staffing models at Baylor University Medical Center. Proc AMIA Symp 2023; 37:70-77. [PMID: 38173989 PMCID: PMC10761084 DOI: 10.1080/08998280.2023.2260671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/08/2023] [Indexed: 01/05/2024] Open
Abstract
Background Baylor University Medical Center benefits from being a quaternary care center with 900+ licensed beds and multiple different models to staff patients on the hospitalist service. These models include hospitalist only, resident teaching teams, and two different advanced practice practitioner teams. The primary goal of this study was to assess these different staffing models and to ascertain which model, if any, has better outcomes related to length of stay, total hospital charges, 30-day readmission rates, patient satisfaction, hospital-acquired infections, mortality, and early discharges. Methods The study was an observational retrospective chart review of all discharges from the hospitalist service at Baylor University Medical Center from October 1, 2021, to February 28, 2022. Patients were included if the hospitalist team was the primary team of record at the time of discharge. A total of 7803 patients were included. Results There was no difference in patient satisfaction, hospital-acquired infections, and mortality between the groups. The teaching teams had a shorter length of stay before the removal of outliers. Independent advanced practice practitioners reliably had more patients discharged before 11:30 am. Results support the concept of continuity of care, as well as lower patient-to-provider ratios. Conclusions These results have actionable implications that support the use of different advanced practice practitioner teams for the safe care of hospitalized patients as well as the safe integration of residents into patient care.
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Affiliation(s)
- Catherine Raver
- Department of Internal Medicine, Baylor University Medical Center, Dallas, TexasUSA
| | - John Bunker
- Department of Internal Medicine, Baylor University Medical Center, Dallas, TexasUSA
| | - Mary Caldwell
- Department of Internal Medicine, Baylor University Medical Center, Dallas, TexasUSA
| | - Luke Eldore
- Texas A&M School of Medicine, Baylor University Medical Center, Dallas, TexasUSA
| | - Cristie Columbus
- Department of Internal Medicine, Baylor University Medical Center, Dallas, TexasUSA
| | - Gerald Ogola
- Department of Biostatistics, Baylor University Medical Center, Dallas, TexasUSA
| | - Kashif Ahmed
- Office of Graduate Medical Education, Baylor University Medical Center, Dallas, TexasUSA
| | - Chieu Au
- Department of Biostatistics, Baylor University Medical Center, Dallas, TexasUSA
| | - Alissa Schick
- Department of Patient Relations, Baylor University Medical Center, Dallas, TexasUSA
| | - Gabriela Perez
- Department of Infection Control, Baylor University Medical Center, Dallas, TexasUSA
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Hooker RS, Christian RL. The changing employment of physicians, nurse practitioners, and physician associates/assistants. J Am Assoc Nurse Pract 2023; 35:487-493. [PMID: 37523244 DOI: 10.1097/jxx.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Indexed: 08/02/2023]
Abstract
ABSTRACT Information on the employment of patient-care clinicians is needed for policy planning and human resource management. The 2021 Bureau of Labor Statistics employment data were probed for occupational settings of 698,700 physicians and surgeons, 246,690 nurse practitioners (NPs), and 139,100 physician associates/assistants (PAs). These three health care professionals accounted for approximately 1.1 million medical and surgical clinicians serving a US population of 331.5 million. Clinician demographics differ-in 2021, the median age of physicians was 45 years; NPs, 43 years; and PAs, 39 years. The largest employment location is "office of a physician" (physician, 53%; NP, 47%; PA, 51%), followed by hospitals (physician, 25%; NP, 25%; PA, 23%), and outpatient centers (physician, 4%; NP, 9%; PA, 10%). The 10-year job outlook predicts physician growth at 3%, NPs at 46%, and PAs at 28%. NP and PA employment is growing more than physicians because of constrained physician postgraduate education funding. Other factors influencing employment changes include medical practice mergers, the rising value of team-based care, the cost of new medical schools, and task shifting.
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Hooker RS, Christian RL. The changing employment of physicians, NPs, and PAs. JAAPA 2023; Published Ahead of Print:01720610-990000000-00066. [PMID: 37399472 DOI: 10.1097/01.jaa.0000944616.43802.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
ABSTRACT Information on the employment of patient-care clinicians is needed for policy planning and human resource management. The 2021 Bureau of Labor Statistics (BLS) employment data were probed for occupational settings of 698,700 physicians and surgeons, 246,690 NPs, and 139,100 physician associates/assistants (PAs). These three healthcare professionals accounted for about 1.1 million medical and surgical clinicians serving a US population of 331.5 million. Clinician demographics differ-in 2021, the median age of physicians was 45 years; NPs, 43 years; and PAs, 39 years. The largest employment location is "office of a physician" (physician, 53%; NP, 47%; PA, 51%), followed by hospitals (physician, 25%; NP, 25%; PA, 23%), and outpatient centers (physician, 4%; NP, 9%; PA, 10%). The 10-year job outlook predicts physician growth at 3%, NPs at 46%, and PAs at 28%. NP and PA employment is growing more than that of physicians because of constrained physician postgraduate education funding. Other factors influencing employment changes include medical practice mergers, the rising value of team-based care, the cost of new medical schools, and task shifting.
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Affiliation(s)
- Roderick S Hooker
- Roderick S. Hooker is a retired health policy analyst. Robert L. Christian is an independent data visual contractor in Portland, Ore. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Shannon EM, Cauley M, Vitale M, Wines L, Chopra V, Greysen SR, Herzig SJ, Kripalani S, O'Leary KJ, Vasilevskis EE, Williams MV, Auerbach AD, Mueller SK, Schnipper JL. Patterns of utilization and evaluation of advanced practice providers on academic hospital medicine teams: A national survey. J Hosp Med 2022; 17:186-191. [PMID: 35504577 DOI: 10.1002/jhm.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/09/2022]
Abstract
This survey study aimed to provide a contemporary appraisal of advanced practice provider (APP) practice and to summarize perceptions of the benefits and challenges of integrating APPs into adult academic hospital medicine (HM) groups. We surveyed leaders of academic HM groups. We received responses from 43 of 86 groups (50%) surveyed. Thirty-four (79%) reported that they employed APPs. In most groups (85%), APPs were reported to perform daily tasks of patient care, including rounding and documentation. Less than half of the groups reported that APPs had completed HM-specific postgraduate training. The reported benefits of APPs included improved perceived quality of care and greater volume of patients that could be seen. Reported challenges included training requirements and support for new hires. Further investigation is needed to determine which APP team structures deliver the highest quality care. There may be a role for expanding standardized competency-based postgraduate training for APPs planning to practice HM.
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Affiliation(s)
- Evan M Shannon
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Marissa Cauley
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew Vitale
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leanne Wines
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vineet Chopra
- Department of Medicine, Division of Hospital Medicine, University of Denver, Denver, Colorado, USA
| | - S Ryan Greysen
- Section of Hospital Medicine, Perelman School of Medicine at the University of Pennsylvania, Division of General Internal Medicine, Philadelphia, Pennsylvania, USA
- The Wharton School at the University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| | - Shoshana J Herzig
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Division of General Medicine, Boston, Massachusetts, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Vanderbilt University Medical Center, Division of General Internal Medicine and Public Health, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin J O'Leary
- Department of Medicine, Northwestern University Feinberg School of Medicine, Division of Hospital Medicine, Chicago, Illinois, USA
| | - Eduard E Vasilevskis
- Section of Hospital Medicine, Vanderbilt University Medical Center, Division of General Internal Medicine and Public Health, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research Education and Clinical Center, VA Tennessee Valley, Nashville, Tennessee, USA
| | - Mark V Williams
- Washington University School of Medicine, Division of Hospital Medicine, St. Louis, Missouri, USA
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Stephanie K Mueller
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey L Schnipper
- Harvard Medical School, Boston, Massachusetts, USA
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Bendicksen D, Pflugeisen CM, Slot FV. A novel inpatient PA staffing model for a community hospital. JAAPA 2022; 35:43-48. [PMID: 34845170 PMCID: PMC8683074 DOI: 10.1097/01.jaa.0000795020.20041.2e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to create a novel physician assistant (PA) and physician hospital medicine co-management strategy, employing a 3:1 PA:physician structure, under which the physician oversees all PA patients, but without a separate independent panel. METHODS This is a retrospective cohort pre-post design, comparing metrics for a traditional physician-only hospitalist model with a PA-physician team model. Outcomes included length of stay (LOS), readmissions, discharge destination, patient satisfaction, and in-hospital mortality. RESULTS LOS for patients under the PA-physician model (74 hours) was lower than for the physician-only model (83 hours; P < .001). The PA-physician model team discharged more patients home than to another facility (PA-physician 77.6%, physician-only 74.3%; P = .03). Thirty-day readmissions were about 10% (P = .97) and patients reported respectful treatment in about 80% (P = .53) of cases in each cohort. CONCLUSIONS Our 3:1 PA-physician model team showed equal to superior outcomes compared with the physician-only hospitalist model.
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Affiliation(s)
- Danielle Bendicksen
- Danielle Bendicksen practiced as a hospitalist PA at MultiCare Health System in Tacoma, Wash. Chaya Mangel Pflugeisen is a research scientist at the MultiCare Institute for Research and Innovation in Tacoma. Franchot van Slot is a hospitalist physician and medical director of the Inpatient Advanced Practice Provider Fellowship at MultiCare Health System and an adjunct professor in the PA program at Pacific University in Forest Grove, Ore. The authors have disclosed no potential conflicts of interest, financial or otherwise
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van den Brink GTWJ, Hooker RS, Van Vught AJ, Vermeulen H, Laurant MGH. The cost-effectiveness of physician assistants/associates: A systematic review of international evidence. PLoS One 2021; 16:e0259183. [PMID: 34723999 PMCID: PMC8559935 DOI: 10.1371/journal.pone.0259183] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The global utilization of the physician assistant/associate (PA) is growing. Their increasing presence is in response to the rising demands of demographic changes, new developments in healthcare, and physician shortages. While PAs are present on four continents, the evidence of whether their employment contributes to more efficient healthcare has not been assessed in the aggregate. We undertook a systematic review of the literature on PA cost-effectiveness as compared to physicians. Cost-effectiveness was operationalized as quality, accessibility, and the cost of care. METHODS AND FINDINGS Literature to June 2021 was searched across five biomedical databases and filtered for eligibility. Publications that met the inclusion criteria were categorized by date, country, design, and results by three researchers independently. All studies were screened with the Risk of Bias in Non-randomised Studies-of Interventions (ROBIN-I) tool. The literature search produced 4,855 titles, and after applying criteria, 39 studies met inclusion (34 North America, 4 Europe, 1 Africa). Ten studies had a prospective design, and 29 were retrospective. Four studies were assessed as biased in results reporting. While most studies included a small number of PAs, five studies were national in origin and assessed the employment of a few hundred PAs and their care of thousands of patients. In 34 studies, the PA was employed as a substitute for traditional physician services, and in five studies, the PA was employed in a complementary role. The quality of care delivered by a PA was comparable to a physician's care in 15 studies, and in 18 studies, the quality of care exceeded that of a physician. In total, 29 studies showed that both labor and resource costs were lower when the PA delivered the care than when the physician delivered the care. CONCLUSIONS Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care. Sometimes this efficiency was due to their reduced labor cost and sometimes because they were more effective as producers of care and activity.
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Affiliation(s)
- G. T. W. J. van den Brink
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands
| | - R. S. Hooker
- Adjunct Professor, Health Policy, Northern Arizona University, United States of America
| | - A. J. Van Vught
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands
| | - H. Vermeulen
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands
| | - M. G. H. Laurant
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands
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Walker RJ, Segon A, Good J, Nagavally S, Gupta N, Levine D, Neuner J, Egede LE. Differences in length of stay by teaching team status in an academic medical center in the Midwestern United States. Hosp Pract (1995) 2021; 49:119-126. [PMID: 33499682 DOI: 10.1080/21548331.2021.1882238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Background: Given the high cost of inpatient stays, hospital systems are investigating ways to decrease lengths of stay while ensuring high-quality care. The goal of this study was to determine if patients in teaching teams (hospitalist teams with residents and interns) had a higher length of stay after adjusting for relevant confounders compared to hospitalist-only teams (staffed only by attending physicians).Methods: Using a retrospective design, we investigated differences in length of stay for 17,577 inpatient encounters over a 2-year period. Length of stay was calculated based on the time between hospital admission and hospital discharge with no removal of outliers. Encounters were assigned to teams based on the discharge provider. Teams were grouped based on whether they were teaching teams or nonteaching teams. Since the length of stay was not normally distributed, it was modeled first using generalized linear models with gamma distribution and log link, and secondly by quantile regression. Models were adjusted for age, gender, race, medicine vs. non-medicine unit, MS-DRGs, and comorbidities.Results: Using gamma models to account for the skewed nature of the data, the length of stay for encounters assigned to teaching teams was 0.56 days longer (β = 0.10 95% CI 0.06 0.14) than for nonteaching teams after adjustment. Using quantile regression, teaching teams had encounters on average 0.63 days longer (95% CI 0.44 0.81) than nonteaching teams at the 75th percentile and 1.19 days longer (95% CI 0.77 1.61) compared to nonteaching teams at the 90th percentile after adjustment.Conclusions: After adjusting for demographics and clinical factors, teaching teams on average had lengths of stay that were over half day longer than nonteaching teams. In addition, for the longest encounters, differences between teaching and nonteaching teams were over 1-day difference. Given these results, process improvement opportunities exist within teaching teams regarding length of stay, particularly for longer encounters.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ankur Segon
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer Good
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sneha Nagavally
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Navdeep Gupta
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Doug Levine
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joan Neuner
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Johnson SA, Ciarkowski CE, Lappe KL, Kendrick DR, Smith A, Reddy SP. Comparison of Resident, Advanced Practice Clinician, and Hospitalist Teams in an Academic Medical Center: Association With Clinical Outcomes and Resource Utilization. J Hosp Med 2020; 15:709-715. [PMID: 33231541 DOI: 10.12788/jhm.3475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Academic medical centers have expanded their inpatient medicine services with advanced practice clinicians (APCs) or nonteaching hospitalists in response to patient volumes, residency work hour restrictions, and recently, COVID-19. Reports of clinical outcomes, cost, and resource utilization differ among inpatient team structures. OBJECTIVE Directly compare outcomes among resident, APC, and solo hospitalist inpatient general medicine teams. DESIGN Retrospective cohort study using multivariable analysis adjusted for time of admission, interhospital transfer, and comorbidities that compares clinical outcomes, cost, and resource utilization. SUBJECTS Patients 18 years or older discharged from an inpatient medicine service between July 2015 and July 2018 (N = 12,716). MAIN MEASURES Length of stay (LOS), 30-day readmission, inpatient mortality, normalized total direct cost, discharge time, and consultation utilization. KEY RESULTS Resident teams admitted fewer patients at night (32.0%; P < .001) than did APC (49.5%) and hospitalist (48.6%) teams. APCs received nearly 4% more outside transfer patients (P = .015). Hospitalists discharged patients 26 minutes earlier than did residents (mean hours after midnight [95% CI], 14.58 [14.44-14.72] vs 15.02 [14.97-15.08]). Adjusted consult utilization was 15% higher for APCs (adjusted mean consults per admission [95% CI], 1.00 [0.96-1.03]) and 8% higher for residents (0.93 [0.90-0.95]) than it was for hospitalists (0.85 [0.80-0.90]). No differences in LOS, readmission, mortality, or cost were observed between the teams. CONCLUSION We observed similar costs, LOS, 30-day readmission, and mortality among hospitalist, APC, and resident teams. Our results suggest clinical outcomes are not significantly affected by team structure. The addition of APC or hospitalist teams represent safe and effective alternatives to traditional inpatient resident teams.
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Affiliation(s)
- Stacy A Johnson
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Claire E Ciarkowski
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Katie L Lappe
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Division of General Internal Medicine, Department of Internal Medicine, George E. Wahlen VA Hospital, Salt Lake City, Utah
| | - David R Kendrick
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Adrienne Smith
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Santosh P Reddy
- Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
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Shahlaie K, Harsh GR. Editorial. The financial value of a neurosurgery resident. J Neurosurg 2020; 135:164-168. [PMID: 32916648 DOI: 10.3171/2020.4.jns20836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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White T, Burns B, Leonard M, Nwabueze C, Quinn M. Comparison of the Outcome of Patient Management with Physician Extenders Only and with both Residents and Extenders. Cureus 2020; 12:e7266. [PMID: 32292677 PMCID: PMC7153817 DOI: 10.7759/cureus.7266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This was a retrospective study that aimed to determine the treatment outcome of patients seen in the trauma unit of the Johnson City Medical Center (JCMC). The study included 2844 patients in the trauma registry and evaluated age, sex, injury severity score (ISS), length of stay (LOS) in the intensive care unit (ICU), overall hospital lengths of stay (LOS), ventilator days, discharge disposition, and complications between one group managed by extenders only and the second managed by both residents and extenders. The sample size of the two groups was similar (group one = 1446 and group two = 1398) and the proportions of males and females in the two groups were identical (males = 65%, females = 35%). Both groups had similar mechanisms of injury, although group one had a higher percentage of falls (32.9% vs. 22.03%) and group two had a higher proportion of motor vehicle crash (MVC) traumas (40.41% vs 30%). There was no significant difference in those discharged home and deaths between the two groups. (χ2(1, N = 2258) = 0.04, p = 0.82). Complications showed statistical significance when looking at extenders vs. residents plus extenders for all complications (χ2(7, N = 196) = 38.73, p ≤ 0.0001). It is possible that having extenders only versus both extenders and residents had no significant difference among the patient outcomes based on the variables age, sex, ISS, ICU days, overall hospital LOS, and ventilator days; however, when observing complications between the two groups, it is possible that patients are more likely to have complications due to overall hospital LOS in the residents plus extenders group.
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Affiliation(s)
- Ted White
- Trauma, Ballad Health Medical Group, Johnson City, USA
| | - Bracken Burns
- Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | | | - Christian Nwabueze
- Epidemiology and Biostatistics, East Tennessee State University, Johnson City, USA
| | - Megan Quinn
- Epidemiology and Public Health, College of Public Health, East Tennessee State University, Johnson City, USA
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Demonstrating advanced practice provider value: Implementing a new advanced practice provider billing algorithm. J Am Assoc Nurse Pract 2019; 31:93-103. [PMID: 30747805 DOI: 10.1097/jxx.0000000000000155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rapid changes in health care are driving the adjustment of work flow by which providers serve patients in team-based care. Specifically, there is a need to develop more effective and efficient utilization with accurate attribution of advanced practice providers' (APPs) productivity. LOCAL PROBLEM The Directors of the APP-Best Practice Center conducted assessments of each clinical area at MUSC Health, a large academic medical center. A knowledge gap was identified, not only regarding billing practices of the APPs (nurse practitioners/physician assistants) but also in the utilization of APPs to practice to the fullest extent of their license, education, and experience. METHODS By substantiating APPs' contribution margin through the process of implementing a new standardized APP billing algorithm, a change in practice was accepted by senior leadership and a new APP billing algorithm was built while following updated practice laws, compliance/legal standards, and hospital bylaws/regulations. INTERVENTIONS A new billing algorithm was implemented on July 1, 2017, and outcomes were evaluated 12 months after implementation. RESULTS This project uncovered the work already performed by APPs while increasing relative value units, collections, and overall patient encounters by the APP/physician team. Findings suggest improved utilization and appropriate attribution of productivity. CONCLUSIONS With the APP work force growing, the implementation of electronic medical record systems, and today's health care financial constraints, it is imperative that health care systems standardize their billing practices. The APP billing algorithm is a critical tool that will help to meet this demand.
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Demonstrating advanced practice provider value: Implementing a new advanced practice provider billing algorithm. JAAPA 2019; 32:1-10. [PMID: 30694959 DOI: 10.1097/01.jaa.0000550293.01522.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rapid changes in healthcare are driving the adjustment of work flow by which providers serve patients in team-based care. Specifically, there is a need to develop more effective and efficient utilization with accurate attribution of advanced practice providers' (APPs) productivity. LOCAL PROBLEM The directors of the APP-Best Practice Center conducted assessments of each clinical area at the Medical University of South Carolina (MUSC) Health, a large academic medical center. A knowledge gap was identified, not only regarding billing practices of the APPs (NPs and physician assistants) but also in the use of APPs to practice to the fullest extent of their license, education, and experience. METHODS By substantiating APPs' contribution margin through the process of implementing a new standardized APP billing algorithm, a change in practice was accepted by senior leadership and a new APP billing algorithm was built that follows updated practice laws, compliance/legal standards, and hospital bylaws and regulations. INTERVENTIONS A new billing algorithm was implemented on July 1, 2017, and outcomes were evaluated 12 months after implementation. RESULTS This project uncovered the work already performed by APPs while increasing relative value units, collections, and overall patient encounters by the APP/physician team. Findings suggest improved utilization and appropriate attribution of productivity. CONCLUSIONS With the APP workforce growing, the implementation of electronic medical record systems, and today's healthcare financial constraints, healthcare systems must standardize their billing practices. The APP billing algorithm is a critical tool that will help to meet this demand.
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Salim SA, Elmaraezy A, Pamarthy A, Thongprayoon C, Cheungpasitporn W, Palabindala V. Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis. J Community Hosp Intern Med Perspect 2019; 9:121-134. [PMID: 31044043 PMCID: PMC6484472 DOI: 10.1080/20009666.2019.1591901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/01/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Over the past 20 years, hospitalists have assumed a greater portion of healthcare service for hospitalized patients. This was mainly due to reducing the length of stay (LOS) and hospital costs shown by many studies. In contrast, other studies suggested increased cost and resources utilization associated with hospitalist-run care models. Aim: We aimed to provide class 1 evidence regarding the effect of hospitalist-run care models on the efficiency of care and patient satisfaction. Design: Meta-analysis. Methods: Four electronic medical databases were searched to retrieve all relevant studies. Two authors screened titles and abstracts of search results for eligibility according to predefined criteria. Initially eligible studies were screened for full text inclusion. Included studies were reviewed for data on LOS, hospital cost, readmission, mortality, and patient satisfaction. Available data were abstracted and analyzed using Comprehensive Meta-Analysis. Results: Sixty-one studies were included for analysis. The overall effect size favored hospitalist-run care models in terms of LOS (MD = -0.67 day, 95% CI [-0.78, -0.56], p < 0.001). There was no significant difference in terms of hospital cost (MD = $92.1, 95% CI [-910.4, 1094.6], p = 0.86) whereas patient satisfaction was similar or even better in hospitalist compared to non-hospitalist (NH) service. Conclusion: Our analysis showed that hospitalist care is associated with decreased LOS and increased patient satisfaction compared to NH. This indicates an increase in the efficiency of care that does not come at the expense of care quality.
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Affiliation(s)
- Sohail Abdul Salim
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ahmed Elmaraezy
- Global Clinical Scholars Research Training (GCSRT) Program, Harvard Medical School, Boston, MA, USA.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Al-Razi Medical Research Academy, Cairo, Egypt
| | - Amaleswari Pamarthy
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
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Bos JM, Timmermans MJC, Kalkman GA, van den Bemt PMLA, De Smet PAGM, Wensing M, Kramers C, Laurant MGH. The effects of substitution of hospital ward care from medical doctors to physician assistants on non-adherence to guidelines on medication prescribing. PLoS One 2018; 13:e0202626. [PMID: 30138432 PMCID: PMC6107206 DOI: 10.1371/journal.pone.0202626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Abstract
AIM This study determined the effect of substitution of inpatient care from medical doctors (MDs) to physician assistants (PAs) on non-adherence to guidelines on medication prescribing. METHODS A multicenter matched-controlled study was performed comparing wards on which PAs provide medical care in collaboration with MDs (PA/MD model), with wards on which only MDs provide medical care (MD model). A set of 17 quality indicators to measure non-adherence to guidelines on medication prescribing by PAs and MDs was composed by 14 experts in a modified Delphi procedure. The indicators covered different pharmacotherapeutic subjects, such as gastric protection in case of use of NSAID or prevention of obstipation in case of use of opioids. These indicators were expressed in proportions by dividing the number of patients in which the prescriber did not adhere to a guideline, by all patients that were applicable. Multivariable regression analysis was performed in order to adjust for potential confounders. RESULTS 1021 patients from 17 hospital wards in the 'PA/MD model' group and 1286 patients from 17 hospital wards in the 'MD model' group were included. Two of the 17 quality indicators showed significantly less non-adherence to guidelines for the PA/MD model; the indicators concerning prescribing gastric protection in case of use of NSAID in combination with corticosteroids (OR 0.42, 95% CI 0.19-0.90) and in case of use of NSAID in patients older than 70 years (OR 0.47, 95% 0.23-0.95). For none of the other quality indicators for prescribing of medication a difference between the MD model and the PA/MD model was found. CONCLUSION This study suggests that the non-adherence to guidelines on medication prescribing on wards with the PA/MD model does not differ from wards with traditional house staffing by MDs only. Further research is needed to determine quality, efficiency and safety of prescribing behavior of PAs.
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Affiliation(s)
- Jacqueline M. Bos
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
- * E-mail:
| | - Marijke J. C. Timmermans
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Gerard A. Kalkman
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - Peter A. G. M. De Smet
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelis Kramers
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
- Department of Clinical Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Miranda G. H. Laurant
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
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15
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Abstract
No consensus definition exists for postgraduate physician assistant (PA) training. This report from the AAPA Task Force on Accreditation of Postgraduate PA Training Programs describes the types of clinical training programs and their effects on hiring and compensation of PAs. Although completing a postgraduate program appears to have no effect on compensation, PAs who complete these programs may be favored in the hiring process and frequently report greater confidence in their skills. More research is needed and program accreditation is key to monitoring the effectiveness of these programs.
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16
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Pittman P, Leach B, Everett C, Han X, McElroy D. NP and PA Privileging in Acute Care Settings: Do Scope of Practice Laws Matter? Med Care Res Rev 2018; 77:112-120. [DOI: 10.1177/1077558718760333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As hospitals’ interest in nurse practitioners (NPs) and physician assistants (PAs) grows, their leadership is eager to know how their medical staffing privileging policies for these professionals compare to peer hospitals. This study assesses the extent of variation of these policies in four clinical areas and examines whether the differences are associated with state scope of practice laws for NPs and PAs. We also examine the relationship of NP and PA privileging policies to each other. Our analysis finds no evidence that hospital privileging is associated with state scope of practice, and indeed within-state variation is more significant than cross-state variation. We also find a strong correlation between NP and PA privileging in all four clinical areas. These results suggest the need for additional research to understand the institutional-level variables and human dynamics at the level of medical staffing committees that may explain the dramatic variation in privileging policies and, ultimately, the effects of different privileging levels on costs and quality.
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Affiliation(s)
| | | | | | - Xinxin Han
- George Washington University, Washington, DC, USA
| | - Debra McElroy
- American Case Management Association, Little Rock, AR, USA
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17
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Goodwin JS, Salameh H, Zhou J, Singh S, Kuo YF, Nattinger AB. Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population. JAMA Intern Med 2018; 178:196-203. [PMID: 29279886 PMCID: PMC5801052 DOI: 10.1001/jamainternmed.2017.7049] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. OBJECTIVE To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. DESIGN, SETTING, AND PARTICIPANTS We used a 5% sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. MAIN OUTCOMES AND MEASURES Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. RESULTS Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25%) had 1 year of experience or less, while 11 596 (54%) had 4 years of experience or more. We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50% for patients of first-year hospitalists vs 9.97% for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95% CI, 0.84-0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33% for patients cared for by first-year hospitalists vs 2.96% for second-year hospitalists. (odds ratio, 0.84; 95% CI, 0.75-0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. CONCLUSIONS AND RELEVANCE Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
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Affiliation(s)
- James S Goodwin
- Department of Medicine, University of Texas Medical Branch, Galveston.,Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Habeeb Salameh
- Department of Medicine, University of Texas Medical Branch, Galveston
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | | | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee
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18
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Timmermans MJC, van Vught AJAH, Peters YAS, Meermans G, Peute JGM, Postma CT, Smit PC, Verdaasdonk E, de Vries Reilingh TS, Wensing M, Laurant MGH. The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study. PLoS One 2017; 12:e0178212. [PMID: 28793317 PMCID: PMC5549960 DOI: 10.1371/journal.pone.0178212] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/09/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients' length of stay (LOS), quality and safety of care, and patient experiences with the provided care. METHODS In a multicenter matched-controlled study, the traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which besides MDs also PAs are employed (PA/MD model). Thirty-four wards were recruited across the Netherlands. Patients were followed from admission till one month after discharge. Primary outcome measure was patients' LOS. Secondary outcomes concerned eleven indicators for quality and safety of inpatient care and patients' experiences with the provided care. RESULTS Data on 2,307 patients from 34 hospital wards was available. The involvement of PAs was not significantly associated with LOS (β 1.20, 95%CI 0.99-1.40, p = .062). None of the indicators for quality and safety of care were different between study arms. However, the involvement of PAs was associated with better experiences of patients (β 0.49, 95% CI 0.22-0.76, p = .001). CONCLUSIONS This study did not find differences regarding LOS and quality of care between wards on which PAs, in collaboration with MDs, provided medical care for the admitted patients, and wards on which only MDs provided medical care. Employing PAs seems to be safe and seems to lead to better patient experiences. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01835444.
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Affiliation(s)
- Marijke J. C. Timmermans
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- * E-mail:
| | | | - Yvonne A. S. Peters
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
| | - Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Bergen op Zoom and Roosendaal, The Netherlands
| | - Joseph G. M. Peute
- Department of Cardiology, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
| | - Cornelis. T. Postma
- Department of Internal Medicine, Radboud university Nijmegen medical center, Nijmegen, The Netherlands
| | - P. Casper Smit
- Department of Surgery, Reinier Haga Groep, Delft, The Netherlands
| | - Emiel Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | | | - Michel Wensing
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Miranda G. H. Laurant
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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19
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Timmermans MJC, van den Brink GT, van Vught AJAH, Adang E, van Berlo CLH, van Boxtel K, Braunius WW, Janssen L, Venema A, van den Wildenberg FJ, Wensing M, Laurant MGH. The involvement of physician assistants in inpatient care in hospitals in the Netherlands: a cost-effectiveness analysis. BMJ Open 2017; 7:e016405. [PMID: 28698344 PMCID: PMC5541617 DOI: 10.1136/bmjopen-2017-016405] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To investigate the cost-effectiveness of substitution of inpatient care from medical doctors (MDs) to physician assistants (PAs). DESIGN Cost-effectiveness analysis embedded within a multicentre, matched-controlled study. The traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which, besides MDs, PAs are also employed (PA/MD model). SETTING 34 hospital wards across the Netherlands. PARTICIPANTS 2292 patients were followed from admission until 1 month after discharge. Patients receiving daycare, terminally ill patients and children were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES All direct healthcare costs from day of admission until 1 month after discharge. Health outcome concerned quality-adjusted life years (QALYs), which was measured with the EuroQol five dimensions questionnaire (EQ-5D). RESULTS We found no significant difference for QALY gain (+0.02, 95% CI -0.01 to 0.05) when comparing the PA/MD model with the MD model. Total costs per patient did not significantly differ between the groups (+€568, 95% CI -€254 to €1391, p=0.175). Regarding the costs per item, a difference of €309 per patient (95% CI €29 to €588, p=0.030) was found in favour of the MD model regarding length of stay. Personnel costs per patient for the provider who is primarily responsible for medical care on the ward were lower on the wards in the PA/MD model (-€11, 95% CI -€16 to -€6, p<0.01). CONCLUSIONS This study suggests that the cost-effectiveness on wards managed by PAs, in collaboration with MDs, is similar to the care on wards with traditional house staffing. The involvement of PAs may reduce personnel costs, but not overall healthcare costs. TRIAL REGISTRATION NUMBER NCT01835444.
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Affiliation(s)
- Marijke J C Timmermans
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen
| | | | | | - Eddy Adang
- Department of Health Evidence, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Charles L H van Berlo
- Department of Surgery Venlo, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
| | - Kim van Boxtel
- Department of Gastroenterology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Weibel W Braunius
- Department of Head and Neck Surgical Oncology, UMC Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Loes Janssen
- Department of Orthopaedics, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands
| | - Alyssa Venema
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Michel Wensing
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Miranda G H Laurant
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen
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20
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21
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Day CS, Boden SD, Knott PT, O'Rourke NC, Yang BW. Musculoskeletal Workforce Needs: Are Physician Assistants and Nurse Practitioners the Solution? AOA Critical Issues. J Bone Joint Surg Am 2016; 98:e46. [PMID: 27252443 DOI: 10.2106/jbjs.15.00950] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Growth estimates and demographic shifts of the population of the United States foreshadow a future heightened demand for musculoskeletal care. Although many articles have discussed this growing demand on the musculoskeletal workforce, few address the inevitable need for more musculoskeletal care providers. As we are unable to increase the number of orthopaedic surgeons because of restrictions on graduate medical education slots, physician assistants (PAs) and nurse practitioners (NPs) represent one potential solution to the impending musculoskeletal care supply shortage. This American Orthopaedic Association (AOA) symposium report investigates models for advanced practice provider integration, considers key issues affecting PAs and NPs, and proposes guidelines to help to assess the logistical and educational possibilities of further incorporating NPs and PAs into the orthopaedic workforce in order to address future musculoskeletal care needs.
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Affiliation(s)
| | - Scott D Boden
- Emory University School of Medicine, Atlanta, Georgia
| | - Patrick T Knott
- Rosalind Franklin University of Medicine and Science, Chicago, Illinois
| | - Nancy C O'Rourke
- Graduate Program of Nursing, George Washington University, Washington, DC
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22
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Timmermans MJC, van Vught AJAH, Van den Berg M, Ponfoort ED, Riemens F, van Unen J, Wobbes T, Wensing M, Laurant MGH. Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands. J Eval Clin Pract 2016; 22:395-402. [PMID: 26695837 DOI: 10.1111/jep.12499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2015] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. METHODS In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. RESULTS We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030). CONCLUSION Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.
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Affiliation(s)
- Marijke J C Timmermans
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Anneke J A H van Vught
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | - Erik D Ponfoort
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Frank Riemens
- Department of Surgery, Van Weel Bethesda Hospital, Dirksland, The Netherlands
| | - Jacco van Unen
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - Theo Wobbes
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Miranda G H Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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23
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Valentin VL, Dehn RW, Baker MD. Commentaries on health services research. JAAPA 2016. [DOI: 10.1097/01.jaa.0000476223.32259.b0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Cawley JF, Hooker RS. Comments: Response to Iannuzzi et al. J Grad Med Educ 2015; 7:689. [PMID: 26692996 PMCID: PMC4675439 DOI: 10.4300/jgme-d-15-00394.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- James F Cawley
- Professor, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University
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25
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26
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Au AG, Padwal RS, Majumdar SR, McAlister FA. Patient outcomes in teaching versus nonteaching general internal medicine services: a systematic review and meta-analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:517-523. [PMID: 24448044 DOI: 10.1097/acm.0000000000000154] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Patient care quality appears to be similar when delivered by trainee and attending physicians. The authors conducted a systematic review and meta-analysis to examine whether outcomes differ for general internal medicine (GIM) patients admitted to teaching versus nonteaching services. METHOD The authors searched Medline, EMBASE, and Cochrane Library databases in May 2012 to identify peer-reviewed, English-language studies with contemporaneous controls comparing inpatient mortality, 30-day readmission rate, and/or length of stay (LOS) for inpatients admitted to teaching or nonteaching GIM services. RESULTS The 15 included studies (1 randomized controlled trial, 14 observational) included 108,570 patients admitted to U.S. hospitals during 1987-2011. Inpatient mortality did not differ between teaching and nonteaching services (13 studies, 108,015 patients; 2.5% versus 2.8%; OR, 1.07; 95% CI, 0.87-1.32; I = 82%); results were consistent in risk-adjusted studies (adjusted OR, 0.91; 95% CI, 0.76-1.08) and higher-quality studies (OR, 0.94; 95% CI, 0.73-1.21). There were no differences in 30-day readmission rates (11 studies, 106,021 patients; 15.1% versus 13.1%; OR, 1.05; 95% CI, 0.93-1.18). Patients on teaching services appeared to have longer LOS (11 studies, 82,352 patients; unadjusted mean difference, 0.40 days; 95% CI, 0.04-0.77 days), but there was substantial heterogeneity (I = 95%). Differences disappeared in risk-adjusted studies (mean difference: -0.09 days; 95% CI, -0.24 to 0.06 days) and in higher-quality studies (mean difference: -0.05 days; 95% CI, -0.37 to 0.28 days). CONCLUSIONS There was no convincing evidence that outcomes differed substantively for patients admitted to teaching or nonteaching GIM services.
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Affiliation(s)
- Anita G Au
- Dr. Au is clinical lecturer, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. Dr. Padwal is associate professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. Dr. Majumdar is professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. Dr. McAlister is professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
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27
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Michtalik HJ, Pronovost PJ, Marsteller JA, Spetz J, Brotman DJ. Identifying potential predictors of a safe attending physician workload: a survey of hospitalists. J Hosp Med 2013; 8:644-6. [PMID: 24124053 PMCID: PMC4087042 DOI: 10.1002/jhm.2088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/19/2013] [Accepted: 08/25/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Henry J. Michtalik
- Department of Medicine, of the Johns Hopkins University, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA
| | - Peter J. Pronovost
- Department of Health Policy & Management of the Johns Hopkins University, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA
| | - Jill A. Marsteller
- Department of Health Policy & Management of the Johns Hopkins University, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Daniel J. Brotman
- Department of Medicine, of the Johns Hopkins University, Baltimore, Maryland, USA
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28
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Torok H, Lackner C, Landis R, Wright S. Learning needs of physician assistants working in hospital medicine. J Hosp Med 2012; 7:190-4. [PMID: 22173947 DOI: 10.1002/jhm.1001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 09/14/2011] [Accepted: 10/16/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hospital Medicine is growing rapidly, and the number of physician assistants (PAs) in this field is expected to grow. However, there is no available data related to the learning needs of PA hospitalists. OBJECTIVE To conduct a needs assessment for PA hospitalists who may be embarking on a hospitalist career. DESIGN Cross-sectional survey based on the Core Competencies in Hospital Medicine. SETTING/PARTICIPANTS A sample of hospitalist PAs working in the United States. MEASUREMENTS Amount of experience with core diagnoses and procedures, preferences for additional training that would have prepared them to function as hospitalist PAs. RESULTS Sixty-nine PAs responded (response rate, 67%). Among the core clinical conditions, respondents had the most experience in managing diabetes and urinary tract infections and were least experienced with health care-associated pneumonias and sepsis syndrome. Over 90% rarely performed core competency procedures other than electrocardiogram and chest X-ray interpretations. The top 3 content areas that PA hospitalists believed would have helped to better prepare them to care for inpatients were palliative care (percent of PAs who agreed or strongly agreed: 85%), nutrition for hospitalized patients (84%), and consultations (64%). Almost all (91%) indicated that they would have been interested in formal postgraduate hospital medicine training even if it meant having a lower stipend during the first year on the job. CONCLUSIONS This is the first national data on self-perceived learning needs of PA hospitalists. The results may prove helpful for both PAs entering hospitalist careers and for the physician groups looking to hire them.
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Affiliation(s)
- Haruka Torok
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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