Background Applications of cost-effectiveness analysis do not typically incorporate effects on caregiver quality of life despite increasing evidence that these effects are measurable. Methods Using a national sample of US adults, we conducted two cross-sectional surveys in December 2011–January 2012. One version asked respondents to value their own experience as the family member of a person with a chronic illness (experienced sample) and the other version asked respondents to value hypothetical scenarios describing the experience of having a family member with a chronic illness (community sample). Conditions included Alzheimer’s disease/dementia, arthritis, cancer, and depression. Using standard gamble questions, respondents were asked to value the spillover effects of a family member’s illness. We used regression analysis to evaluate the disutility (loss in health-related quality of life) of having a family member with a chronic illness by condition and relationship type controlling for respondent’s own conditions and sociodemographic characteristics. Results For the experienced sample (n=1389), regression analyses suggested greater spillover was associated with certain conditions (arthritis, depression) compared with other conditions (Alzheimer’s disease, cancer). For the community sample (n=1205), regression analyses indicated that lower spillover was associated with condition (cancer) but not the type of relationship with the ill family member (parent, child, spouse). Conclusions The effects of illness extend beyond the individual patient to include effects on caregivers of patients, parents of ill children, spouses, and other close family and household members. Cost-effectiveness analyses should consider the inclusion of health-related quality of life spillover effects in addition to caregiving time costs incurred by family members of ill individuals.

Background Given the broad scope of the spillover effects of illness, it is important to characterize the variability in these outcomes in order to identify relationship types in which secondary impacts of illness are particularly important to include in health economic evaluations. Purpose To examine heterogeneity in spillover effects of chronic conditions on family members by type of familial relationship with patient. Methods Adults (≥18 years) and adolescents (13-17 years) who had a parent, spouse or child in their household with a chronic condition (including Alzheimer's disease/dementia, arthritis, cancer and depression) were recruited from a U.S. national panel to participate in an on-line survey. Respondents were asked to rate the spillover effect of their family member's illness on their own health on a 0-100 scale, with lower scores indicating greater spillover. Regression analysis was used to evaluate the association between rating scale scores and relationship with ill family member (ill parent, child, or spouse) for each illness separately, controlling for caregiving responsibility and the health status of the ill family member. Results 1267 adults and 102 adolescents met inclusion criteria. In adjusted analyses, having a sick child was significantly (p<0.05) associated with lower rating scale scores compared to having a spouse with the same condition (cancer: -24.2; depression -9.7). Having a non-elderly or elderly adult parent with a condition, compared to a spouse, was significantly associated with lower rating scale scores for arthritis (-3.8) and depression (-5.3), but not for Alzheimer's disease/dementia or cancer. Conclusions The impact of illness on family members, measured with a rating scale, varies by relationship type for certain illnesses. Having a child with cancer, a parent with arthritis, or either with depression, is significantly associated with greater spillover, compared to having a spouse with one of these conditions.

The majority of PNPs currently work in primary care, and most do not have any inpatient roles. It does not seem that independent PNP practices are responsible for a significant portion of pediatric visits. For those who posit that PNPs will help alleviate the currently perceived shortage of pediatric subspecialists, our findings indicate that it likely will not occur without a significant change in the PNP workforce distribution.

As with many health care professionals, the supply of NNPs may not be distributed according to need. With increasing concern regarding the availability of NNPs, comprehensive studies that examine the demand for NNPs and the roles of other clinicians in the NICU should provide a greater understanding of appropriate NICU workforce capacity and needs.