Kartha Anand, Restuccia Joseph D, Burgess James F, Benzer Justin, Glasgow Justin, Hockenberry Jason, Mohr David C, Kaboli Peter J
Center for Healthcare Organization and Implementation Research (CHOIR) at the VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
J Hosp Med. 2014 Oct;9(10):615-20. doi: 10.1002/jhm.2231. Epub 2014 Sep 16.
Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine.
Describe APPs role in inpatient medicine.
Observational cross-sectional cohort study.
One hundred twenty-four Veterans Health Administration (VHA) hospitals.
Chiefs of medicine (COMs) and nurse managers.
Surveys included inpatient medicine scope of practice for APPs and perceived healthcare quality. We conducted bivariate unadjusted and multivariable adjusted analyses.
One hundred eighteen COMs (95.2%) and 198 nurse managers (75.0%) completed surveys. Of 118 medicine services, 56 (47.5%) employed APPs; 27 (48.2%) used NPs only, 15 (26.8%) PAs only, and 14 (25.0%) used both. Full-time equivalents for NPs was 0.5 to 7 (mean = 2.22) and PAs was 1 to 9 (mean = 2.23). Daily caseload was similar at 4 to 10 patients (mean = 6.5 patients). There were few significant differences between tasks. The presence of APPs was not associated with patient or nurse manager satisfaction. Presence of NPs was associated with greater overall inpatient and discharge coordination ratings by COMs and nurse managers, respectively; the presence of PAs was associated with lower overall inpatient coordination ratings by nurse managers.
NPs and PAs work on half of VHA inpatient medicine services with broad, yet similar, scopes of practice. There were few differences between their roles and perceptions of care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs.
高级执业人员（APPs），包括执业护士（NPs）和医师助理（PAs），是具有成本效益的医生替代人员，在初级保健和外科手术中能取得相似的治疗效果。然而，对于APPs在住院医疗中的作用了解甚少。
描述APPs在住院医疗中的作用。
观察性横断面队列研究。
124家退伍军人健康管理局（VHA）医院。
内科主任（COMs）和护士长。
调查内容包括APPs在住院医疗中的执业范围以及对医疗质量的认知。我们进行了双变量未调整分析和多变量调整分析。
118名内科主任（95.2%）和198名护士长（75.0%）完成了调查。在118个内科科室中，56个（47.5%）雇佣了APPs；27个（48.2%）仅使用执业护士，15个（26.8%）仅使用医师助理，14个（25.0%）两者都使用。执业护士的全职等效人数为0.5至7（平均=2.22），医师助理为1至9（平均=2.23）。每日病例数相似，为4至10例患者（平均=6.5例患者）。任务之间几乎没有显著差异。APPs的存在与患者或护士长的满意度无关。执业护士的存在分别与内科主任和护士长对住院期间整体和出院协调的更高评分相关；医师助理的存在与护士长对住院期间整体协调的较低评分相关。
执业护士和医师助理在一半的VHA住院内科服务中工作，其执业范围广泛但相似。他们在角色和护理认知方面几乎没有差异。鉴于他们背景、监管和报销方式差异很大，这对计划雇佣执业护士或医师助理的住院内科服务有一定影响。
