Match!

Nurse Practitioners' and Physicians' Care Activities and Clinical Outcomes With an Inpatient Geriatric Population

Published on Aug 1, 2004in Journal of The American Academy of Nurse Practitioners
· DOI :10.1111/j.1745-7599.2004.tb00457.x
Angela Y. Lambing1
Estimated H-index: 1
(HFHS: Henry Ford Health System),
Denise L. C. Adams1
Estimated H-index: 1
+ 1 AuthorsGeorge Divine29
Estimated H-index: 29
(HFHS: Henry Ford Health System)
Abstract
Objective Less is known about nurse practitioners' (NPs') effectiveness in acute care than about their effectiveness in outpatient settings. This study investigated care activities and clinical outcomes for hospitalized geriatric patients treated by NPs compared with those treated by intern and resident physicians. Data Sources A descriptive comparative research design involved random selection of 100 inpatient geriatric patients and a convenience sample of 17 professional providers who staffed three hospital units. A 1-month study period produced retrospective and prospective data for analysis. Self-reports concerning 10 primary activity categories indicated that NPs spent a higher percentage of time doing progress notes and care planning than did physicians (28% versus 15%, p=.011) and that physicians spent more time on literature reviews (5% versus 1%, p=.008). When prioritizing care activities, NPs ranked advance directive discussion higher than did physicians (2nd versus 7th, p=.036), a difference confirmed by medical record documentation. Physicians were more attentive to functional status (1st versus 3rd, p=.023), but medical record documentation showed NPs to be more attentive to physical and occupational therapy referrals (p=.001). Analysis of 13 independent organ areas revealed that NPs cared for more musculoskeletal (p=.036) and psychiatric (p=.005) problems. Physicians cared for more cardiac patients (p=.001). NPs’ patients were older (p=.022) and sicker at admission (p <. 001) and discharge (p <. 001). Charges per length of stay were lower (p <. 001) for the physician provider group, and patients in that group had shorter stays (p <. 001). Readmission and mortality rates were similar. Implications for Practice NPs provide effective care to hospitalized geriatric patients, particularly to those who are older and sicker.
  • References (40)
  • Citations (17)
📖 Papers frequently viewed together
200051.27JAMA
744 Citations
200227.60BMJ
3 Authors (Sue Horrocks, ..., Chris Salisbury)
958 Citations
216 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References40
Newest
1,284 CitationsSource
OBJECTIVES: To measure and describe medical comorbidity in geriatric rehabilitation patients and investigate its relationship to rehabilitation efficiency. DESIGN: Prospective, multivariate, within-subject design. SETTING: The Geriatric Rehabilitation inpatient unit of the SCO Health Service in Ottawa, Canada. PARTICIPANTS: One hundred ten patients, with a mean age of 82 years. MEASUREMENTS: The rehabilitation efficiency ratio, based on gains in functional status achieved with rehabilitation tre...
119 CitationsSource
#1William M. Tierney (IU: Indiana University)H-Index: 76
#2Paul R. Dexter (IU: Indiana University)H-Index: 25
Last. Fredric D. Wolinsky (SLU: Saint Louis University)H-Index: 62
view all 6 authors...
BACKGROUND: Discussions of end-of-life care should be held prior to acute, disabling events. Many barriers to having such discussions during primary care exist. These barriers include time constraints, communication difficulties, and perhaps physicians’ anxiety that patients might react negatively to such discussions.
172 CitationsSource
Wavelength dispersion in an optical demultiplexer is accomplished by varying propagation constants of a central pathway traverse to the direction of wavefront propagation through the central pathway. The propagation constant can be varied by changing the dimensions or refractive qualities of the central pathway, which can be formed as a common waveguide or as a plurality of individual waveguides.
63 CitationsSource
#1Mary O. Mundinger (Columbia University)H-Index: 13
#2Chad BoultH-Index: 93
Last. Michael L. Shelanski (Columbia University)H-Index: 51
view all 9 authors...
ContextStudies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians. However, these studies did not measure nurse practitioner practices that had the same degree of independence as the comparison physician practices, nor did previous studies provide direct comparison of outcomes for patients with nurse practitioner or physician providers.ObjectiveTo compare outcomes for patients randomly assigned to nurse practitioners or physicians for ...
744 CitationsSource
#1Gail L. IngersollH-Index: 10
#2Roxane SpitzerH-Index: 1
Last. Jo-Ann CookH-Index: 4
view all 3 authors...
A review of research pertaining to managed care suggests that little information is known about the impact of the components of managed care on care delivery outcomes. Characteristics of managed-care systems rarely are considered, resulting in uncertainty and confusion about which of the domain comp
4 CitationsSource
#1Jo-Ann CookH-Index: 4
#2Gail L. IngersollH-Index: 10
Last. Roxanne SpitzerH-Index: 2
view all 3 authors...
11 CitationsSource
#1Jo-Ann CookH-Index: 4
#2Gail L. IngersollH-Index: 10
Last. Roxanne SpitzerH-Index: 2
view all 3 authors...
New research opportunities are arising in response to the changes associated with care delivery provided in managed-care environments. A review of the managed-care literature suggests five characteristics that are associated with the care delivery models currently in place. Each of these components
5 Citations
#1Bruce J. Naughton (UB: University at Buffalo)H-Index: 22
#2Susan SaltzmanH-Index: 3
Last. Joseph M. Mylotte (UB: University at Buffalo)H-Index: 34
view all 5 authors...
OBJECTIVE: To compare the Cumulative Illness Rating Scale (CIRS) and the Nursing Severity Index (NSI) as independent predictors of discharge outcome from a post-acute GEM unit and to define a multivariate model for predicting the same outcome. DESIGN: Retrospective chart review for the entire sample. The sample was split into two cohorts, a derivation cohort (n = 298) and a validation cohort (n = 154). SETTING: A 20-bed, post-acute GEM unit in a nonproprietary skilled nursing facility. PARTICIPA...
12 CitationsSource
13 CitationsSource
Cited By17
Newest
Abstract Aim and Methods This study compared clinical and financial outcomes in post–percutaneous coronary intervention (PCI) ambulatory patients (n = 308) managed by advanced practice providers (APPs) versus cardiologists (Physician Providers [PPs]) over a period of 12 months. Results Both groups (PPs, n = 164; APPs, n = 144) were similar in their baseline characteristics and experienced similar rates of major adverse cardiac events (12% vs. 13%; p = 0.792) as well as mortality (3% vs. 6.2%; P ...
Source
Abstract Introduction Evidence suggests that urinary and fecal incontinence and abnormal voiding and defecation dynamics are different manifestations of the same syndrome. This article reports the success of an innovative program for care of children with incontinence and dysfunctional elimination. This program is innovative because it is the first to combine subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population and the first reported ind...
Source
#1Krista S. Chavez (UNIL: University of Lausanne)H-Index: 1
#2Andrew A. Dwyer (UNIL: University of Lausanne)H-Index: 34
Last. Anne-Sylvie Ramelet (UNIL: University of Lausanne)H-Index: 11
view all 3 authors...
Abstract Objectives To identify and summarize the common clinical settings, interventions, and outcomes of nurse practitioner care specific to older people. Design Scoping review of the international published and grey literature. Data sources A structured literature search was conducted of CINAHL, EMBASE, MEDLINE, Google Scholar, and Cochrane Collaboration and Joanna Briggs Institute databases. Review methods Following the Arksey and O'Malley framework, randomized controlled and quasi-experimen...
8 CitationsSource
Purpose: Dental hygienists have often been described as the registered nurses of the dental field. Similar parallels also exist between the development of the nurse practitioner from the nursing profession and the evolution of the dental hygiene practice and profession. This article explores 3 major similarities between the professions of nurse practitioner and dental hygienist. Public health issues, educational constructs, and the social and political environments shaping each profession are di...
1 Citations
#1Julie Stanik-Hutt (Johns Hopkins University)H-Index: 11
#2Robin P. Newhouse (UMB: University of Maryland, Baltimore)H-Index: 22
Last. Jonathan P. Weiner (Johns Hopkins University)H-Index: 38
view all 11 authors...
Abstract Evidence regarding the impact of nurse practitioners (NPs) compared to physicians (MDs) on health care quality, safety, and effectiveness was systematically reviewed. Data from 37 of 27,993 articles published from 1990-2009 were summarized into 11 aggregated outcomes. Outcomes for NPs compared to MDs (or teams without NPs) are comparable or better for all 11 outcomes reviewed. A high level of evidence indicated better serum lipid levels in patients cared for by NPs in primary care setti...
98 CitationsSource
AbstractPurpose:Unexpected bleeding or hemorrhage related to the development of acquired factor VIII inhibitors is an emerging clinical challenge in patients. Symptoms can occur suddenly with bleeding and/or bruising that is excessive relative to the degree of injury or severity of a comorbid condit
Source
#1Beth Ann Norton (Harvard University)H-Index: 1
#2Rosemarie ThomasH-Index: 1
Last. Sharon Dudley-BrownH-Index: 1
view all 4 authors...
Aim To understand the impact of Crohn’s disease (CD) on various aspects of daily life from the perspective of patients living with CD. Awareness of the disease and biologic therapies, patient satisfaction and adherence, and physician (provider) relationships were also assessed.
13 CitationsSource
8 CitationsSource
#1Elizabeth M. BluntH-Index: 1
5 Citations