Nonphysician providers in the hospitalist model: A prescription for change and a warning about unintended side effects

Ford, W. T.; Britting, Lorraine

doi:10.1002/jhm.556

Cited by 11 publications

(13 citation statements)

References 8 publications

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“…Reasons for this reallocation are an increased appreciation of continuity of care, a growing pressure to deliver healthcare efficiently and a (local) shortage of physicians. [3][4][5] A PA is a non-physician healthcare professional licensed to practice medicine in defined domains, with variable degrees of professional autonomy. 6 In the Netherlands, the autonomy of PA practice varies considerably with experience, training, practice setting and employer expectations.…”

Section: Introductionmentioning

confidence: 99%

Determinants of the sustained employment of physician assistants in hospitals: a qualitative study

Timmermans

Vught

Maassen³

et al. 2016

BMJ Open

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Section: Introductionmentioning

confidence: 99%

Determinants of the sustained employment of physician assistants in hospitals: a qualitative study

Timmermans

Vught

Maassen³

et al. 2016

BMJ Open

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“…Most APP studies have focused on the outpatient setting, despite nearly a third of US healthcare expenditure for hospital care . Little is known about APP involvement, specific roles, or impact on outcomes in inpatient medicine settings where they are often referred to as NP or PA “hospitalists.”…”

mentioning

confidence: 99%

Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals

Kartha

Restuccia

Burgess

et al. 2014

Journal of Hospital Medicine

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“…This body of evidence suggests that PAs can provide high-quality care in a large range of medical disciplines [11-14]. The studies indicate that they provide care that is comparable to that of MDs, with high levels of patient satisfaction [15-18].…”

Section: Introductionmentioning

confidence: 99%

“…This role has traditionally been fulfilled by medical residents (MRs) and occasionally by medical specialists. In recent years, the role of hospitalist has been increasingly reallocated to PAs [3,11], facilitated by technological innovations and the standardization of many medical procedures by clinical protocols [20,21]. In 2013, approximately 200 graduated PAs were employed as hospitalist in the Netherlands.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol

Timmermans

Vught

Wensing

et al. 2014

BMC Health Serv Res

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BackgroundBecause of an expected shrinking supply of medical doctors for hospitalist posts, an increased emphasis on efficiency and continuity of care, and the standardization of many medical procedures, the role of hospitalist is increasingly allocated to physician assistants (PAs). PAs are nonphysician clinicians with medical tasks. This study aims to evaluate the effects of substitution of hospital ward care to PAs.Methods/DesignIn a multicenter matched controlled study, the traditional model in which the role of hospitalist is taken solely by medical doctors (MD model) is compared with a mixed model in which a PA functions as a hospitalist, contingent with MDs (PA/MD model). Twenty intervention and twenty control wards are included across The Netherlands, from a range of medical specialisms. Primary outcome measure is patients’ length of hospital stay. Secondary outcomes include indicators for quality of hospital ward care, patients experiences with medical ward care, patients health-related quality of life, and healthcare providers’ experiences. An economic evaluation is conducted to assess the cost implications and potential efficiency of the PA/MD model. For most measures, data is collected from medical records or questionnaires in samples of 115 patients per hospital ward. Semi-structured interviews with healthcare professionals are conducted to identify determinants of efficiency, quality and continuity of care and barriers and facilitators for the implementation of PAs in the role of hospitalist.DiscussionFindings from this study will help to further define the role of nonphysician clinicians and provides possible key components for the implementation of PAs in hospital ward care. Like in many studies of organizational change, random allocation to study arms is not feasible, which implies an increased risk for confounding. A major challenge is to deal with the heterogeneity of patients and hospital departments.Trial registrationClinicalTrials.gov ID NCT01835444

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Nonphysician providers in the hospitalist model: A prescription for change and a warning about unintended side effects

Cited by 11 publications

References 8 publications

Determinants of the sustained employment of physician assistants in hospitals: a qualitative study

Determinants of the sustained employment of physician assistants in hospitals: a qualitative study

Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals

The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol

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