Physician assistant and nurse practitioner utilization in U.S. emergency departments, 2010 to 2017

Wu, Fcw; Darracq, Michael A.

doi:10.1016/j.ajem.2020.06.032

Cited by 12 publications

(14 citation statements)

References 8 publications

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“…Many studies investigated the scope of PA practice, often comparing PA responsibilities with those of nurse practitioners (NPs) 24,26,32,34,37,38 . Wu et al (2020) compared new graduate PAs to NPs and reported that PAs are better clinically prepared to work in the ED, because PAs' education is based on a medical model, the same model doctors are trained on, as opposed to the nursing care model 34 . Bloemhoff et al reported that in the Netherlands EDs, PAs ordered fewer investigations and consulted with other specialties more than NPs (33% vs 17%; P < 0.001) as opposed to referring patients (50% vs 73%, P < 0.0001) 37 .…”

Section: Resultsmentioning

confidence: 99%

“…Many studies investigated the scope of PA practice, often comparing PA responsibilities with those of nurse practitioners (NPs). 24,26,32,34,37,38 34 Bloemhoff et al reported that in the Netherlands EDs, PAs ordered fewer investigations and consulted with other specialties more than NPs (33% vs 17%; P < 0.001) as opposed to referring patients (50% vs 73%, P < 0.0001). 37 However, PAs and NPs were similar in terms of imaging requested, diagnostic screening, procedures performed, medications ordered, or hospital admission rates.…”

Section: Experience and Scope Of Practicementioning

confidence: 99%

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The contribution of physician associates or assistants to the emergency department: A systematic scoping review

2023

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Funding and support: By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Nicole M. A. King and Munaf Habeeb are professional doctorate students and Suzannah Helps is a senior lecturer.

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Section: Resultsmentioning

confidence: 99%

Section: Experience and Scope Of Practicementioning

confidence: 99%

The contribution of physician associates or assistants to the emergency department: A systematic scoping review

2023

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“…Three studies using the National Hospital Ambulatory Medical Care Survey showed fewer imaging studies for ED visits managed by NPPs vs physicians. 28 , 29 , 30 However, 2 of those studies 28 , 29 were descriptive only and did not control for patient and hospital characteristics. Although the third study 30 included these controls, all 3 studies lacked the clinical data necessary to fully risk adjust ED visits to make a fair comparison of ED visits with NPPs vs physicians.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies using the National Hospital Ambulatory Medical Care Survey showed fewer imaging studies for ED visits managed by NPPs vs physicians . However, 2 of those studies were descriptive only and did not control for patient and hospital characteristics.…”

Section: Discussionmentioning

confidence: 99%

Association of State Share of Nonphysician Practitioners With Diagnostic Imaging Ordering Among Emergency Department Visits for Medicare Beneficiaries

et al. 2022

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ImportanceThe use of nonphysician practitioners (NPPs) in the emergency department (ED) continues to expand, yet little is known about associations between NPPs and ED imaging use.ObjectiveTo investigate whether the state share of ED visits for which an NPP was the clinician of record is associated with imaging studies ordered, given that state NPP share is associated with state-level NPP scopes of practice.Design, Setting, and ParticipantsThis cross-sectional study compared diagnostic imaging ordering patterns associated with ED visits based on 2005-2020 Medicare claims for a nationally representative 5% sample of fee-for-service beneficiaries. For all 50 states and the District of Columbia, the state NPP share of ED visits by year was used to represent state-specific practice patterns for NPPs and physicians and how those patterns have evolved over time. The analysis controlled for patient demographic characteristics, Charlson Comorbidity Index scores, ED visit severity, year, and principal diagnosis.ExposuresThe share of ED visits in each state in each year (state share) for which an NPP was the evaluation and management clinician.Main Outcomes and MeasuresThe main outcomes were the number and modality of imaging studies associated with ED visits. Analyses were by logistic regression and generalized linear model with γ-distribution and log-link function.ResultsAmong 16 922 274 ED visits, 60.0% involved women, and patients’ mean (SD) age was 70.3 (16.1) years. The share of all ED visits with an NPP as the clinician increased from 6.1% in 2005 to 16.6% in 2020. Compared with no NPPs, the presence of NPPs in the ED was associated with 5.3% (95% CI, 5.1%-5.5%) more imaging studies per ED visit, including a 3.4% (95% CI, 3.2%-3.5%) greater likelihood of any imaging order per ED visit and 2.2% (95% CI, 2.0%-2.3%) more imaging studies ordered per visit involving imaging.Conclusions and RelevanceIn this study, use of NPPs in the ED was associated with higher imaging use compared with the use of only physicians in the ED. Although expanded use of NPPs in the ED may improve patient access, the costs and radiation exposure associated with more imaging warrants additional study.

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“…Policies permitting independent APP practice with indirect physician support have been implemented by many states to facilitate staffing of rural geographies or safety net providers. Concerns exist regarding the expanding practice patterns of APPs, yet prior analyses have suggested the potential for APP replacement of physician care for higher acuity patients to be unfounded 7,8 . To date, there has not been detailed assessment of APP independent service provision in nationally representative data to determine how practice patterns have changed, particularly regarding high‐acuity emergency care.…”

Section: Introductionmentioning

confidence: 99%

Rising high‐acuity emergency care services independently billed by advanced practice providers, 2013 to 2019

Gettel

Schuur

Mullen³

et al. 2022

Academic Emergency Medicine

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Background: Advanced practice providers (APPs) comprise an increasing proportion of the emergency medicine (EM) workforce, particularly in rural geographies. With little known regarding potential expanding practice patterns, we sought to evaluate trends in independent emergency care services billed by APPs from 2013 to 2019. Methods: We performed a repeated cross-sectional analysis of emergency clinicians independently reimbursed for at least 50 evaluation and management (E/M) services (99281-99285, 99291) from Medicare Part B, with high-acuity services including Codes 99285 and 99291. We describe the outcome proportion of E/M services by acuity level and report at (1) the encounter level and (2) at the clinician level. We stratified analyses by clinician type and geography.

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Physician assistant and nurse practitioner utilization in U.S. emergency departments, 2010 to 2017

Cited by 12 publications

References 8 publications

The contribution of physician associates or assistants to the emergency department: A systematic scoping review

The contribution of physician associates or assistants to the emergency department: A systematic scoping review

Association of State Share of Nonphysician Practitioners With Diagnostic Imaging Ordering Among Emergency Department Visits for Medicare Beneficiaries

Rising high‐acuity emergency care services independently billed by advanced practice providers, 2013 to 2019

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