2.50
Hdl Handle:
http://hdl.handle.net/10755/158222
Type:
Presentation
Title:
Comparing NP and MD primary care outcomes: Two-year follow-up
Abstract:
Comparing NP and MD primary care outcomes: Two-year follow-up
Conference Sponsor:Western Institute of Nursing
Conference Year:2001
Author:Mundinger, Mary
P.I. Institution Name:Columbia University
Contact Address:School of Nursing, 630 West 168th Street, New York, NY, 10032, USA
Contact Telephone:212.305.3582
Statement of the problem. Since the inception of the nurse practitioner (NP) role, evidence has been accruing that the quality of care provided by NP's is equal to that provided by physicians. However, few studies have permitted the direct comparison of NP and MD primary care practices that are virtually identical with identical administrative structures and resources, productivity requirements, and patient populations except for the discipline of the providers. The purpose of this paper is to report the results of the 2-year follow-up of patients who participated in a randomized study comparing patient outcomes for NP and MD primary care practices which differed only in the type of provider. The main hypothesis was that there would be no differences between the NP and MD groups in functional health status, clinical health status, satisfaction with care, and health care utilization. The initial round of outcomes data collection occurred at 6 months following the initial visit to the assigned provider. At that point, no clinically significant differences were found between the two groups. However, it is possible that the 6-month interval may not have been long enough to allow differences between the two groups to emerge, so a 2-year follow-up study was carried out. Sample. A total of 1316 patients were randomized to one of the two types of provider practices, received care from the assigned practice, and provided baseline health status data. Attempts were made to locate 1140 of these subjects two years following their initial visit to the provider. A total of 735 patients (65.7% of the eligible sample) were interviewed. Of these, 217 received care within the year prior to data collection and continued to see their originally assigned provider as their sole source of primary health care. It is this relatively small sub-sample to whom the intervention provision of primary care by the initially assigned NP or MD practice was "delivered" most strongly. It was decided to focus the analysis on this sub-sample, acknowledging problems resulting from low statistical power. The 217 patients were predominantly middle aged (40-64), female, Hispanic, and enrolled in Medicaid. A majority (59%) had at least one of the three targeted chronic conditions. Method. Patients were interviewed regarding their health status (SF-36) and satisfaction with care received at the assigned practice (using the Primary Care Assessment Survey). Physiologic measures (blood pressure, glycosylated hemoglobin and peak flow) were collected from patients with hypertension, diabetes and asthma, respectively. Health service utilization was measured using hospital billing data. Data analysis included independent and paired t-tests and Chi Square analyses. Results. At 2 years, there were no statistically significant differences between NP and MD patients on any of the outcomes measured: health status, physiologic measures, satisfaction, and use of primary care, specialist, emergency and inpatient services. Health status (SF-36 scores) was higher than at baseline, but lower than at 6-months score; physiologic measures did not change from 6 months. Conclusion. The conclusion of the 2-year follow-up is consistent with that of the 6-month analysis: the primary health care delivered by NPs and MDs is equal in quality. Thus, the original finding was not an artifact of the measurement interval, but a persistent pattern.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleComparing NP and MD primary care outcomes: Two-year follow-upen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158222-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Comparing NP and MD primary care outcomes: Two-year follow-up</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Mundinger, Mary</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Columbia University</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">School of Nursing, 630 West 168th Street, New York, NY, 10032, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">212.305.3582</td></tr><tr><td colspan="2" class="item-abstract">Statement of the problem. Since the inception of the nurse practitioner (NP) role, evidence has been accruing that the quality of care provided by NP's is equal to that provided by physicians. However, few studies have permitted the direct comparison of NP and MD primary care practices that are virtually identical with identical administrative structures and resources, productivity requirements, and patient populations except for the discipline of the providers. The purpose of this paper is to report the results of the 2-year follow-up of patients who participated in a randomized study comparing patient outcomes for NP and MD primary care practices which differed only in the type of provider. The main hypothesis was that there would be no differences between the NP and MD groups in functional health status, clinical health status, satisfaction with care, and health care utilization. The initial round of outcomes data collection occurred at 6 months following the initial visit to the assigned provider. At that point, no clinically significant differences were found between the two groups. However, it is possible that the 6-month interval may not have been long enough to allow differences between the two groups to emerge, so a 2-year follow-up study was carried out. Sample. A total of 1316 patients were randomized to one of the two types of provider practices, received care from the assigned practice, and provided baseline health status data. Attempts were made to locate 1140 of these subjects two years following their initial visit to the provider. A total of 735 patients (65.7% of the eligible sample) were interviewed. Of these, 217 received care within the year prior to data collection and continued to see their originally assigned provider as their sole source of primary health care. It is this relatively small sub-sample to whom the intervention provision of primary care by the initially assigned NP or MD practice was &quot;delivered&quot; most strongly. It was decided to focus the analysis on this sub-sample, acknowledging problems resulting from low statistical power. The 217 patients were predominantly middle aged (40-64), female, Hispanic, and enrolled in Medicaid. A majority (59%) had at least one of the three targeted chronic conditions. Method. Patients were interviewed regarding their health status (SF-36) and satisfaction with care received at the assigned practice (using the Primary Care Assessment Survey). Physiologic measures (blood pressure, glycosylated hemoglobin and peak flow) were collected from patients with hypertension, diabetes and asthma, respectively. Health service utilization was measured using hospital billing data. Data analysis included independent and paired t-tests and Chi Square analyses. Results. At 2 years, there were no statistically significant differences between NP and MD patients on any of the outcomes measured: health status, physiologic measures, satisfaction, and use of primary care, specialist, emergency and inpatient services. Health status (SF-36 scores) was higher than at baseline, but lower than at 6-months score; physiologic measures did not change from 6 months. Conclusion. The conclusion of the 2-year follow-up is consistent with that of the 6-month analysis: the primary health care delivered by NPs and MDs is equal in quality. Thus, the original finding was not an artifact of the measurement interval, but a persistent pattern.</td></tr></table>en_GB
dc.date.available2011-10-26T20:37:54Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:37:54Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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