Hill Chloe E, Thomas Bethany, Sansalone Kimberly, Davis Kathryn A, Shea Judy A, Litt Brian, Dahodwala Nabila
Departments of Neurology (CEH, BT, KS, KAD, BL, ND) and Medicine (JAS), University of Pennsylvania, Philadelphia.
Neurol Clin Pract. 2017 Apr;7(2):109-117. doi: 10.1212/CPJ.0000000000000337.
This study investigated the quality of care delivered by nurse practitioner (NP)-physician teams employed to expand clinic appointment availability for patients with epilepsy.
We performed a retrospective observational cohort study of patients with epilepsy presenting to the Penn Epilepsy Center for a new patient appointment in 2014. During this time, patients were seen either by an NP-physician team care model or a more traditional physician-only care model. These care models were compared with regard to adherence to the 2014 American Academy of Neurology epilepsy quality measures at the initial visit. Clinical outcomes of seizure frequency, presentations to the Emergency Department, injury, and death were assessed over the subsequent year.
A total of 169 patients were identified by our inclusion and exclusion criteria: 65 patients in the NP-physician team care model cohort and 104 patients in the physician-only care model cohort. The NP-physician team care model saw, on average, 3 more patients per clinic session. There were no meaningful differences between these cohorts in baseline characteristics. The NP-physician team care model showed equivalent adherence to the physician-only care model for the epilepsy quality measures, with superior adherence to the counseling measures of querying for side effects, provision of personalized epilepsy safety education, and screening for behavioral health disorders. The 2 care models performed similarly in all clinical outcomes.
An NP-physician team care model employed to increase availability of care could also improve quality of care delivered.
本研究调查了为增加癫痫患者门诊预约机会而组建的执业护士（NP）-医师团队所提供的护理质量。
我们对2014年前往宾夕法尼亚癫痫中心进行新患者预约的癫痫患者进行了一项回顾性观察队列研究。在此期间，患者接受了NP-医师团队护理模式或更传统的仅由医师提供的护理模式。比较了这些护理模式在初次就诊时对2014年美国神经病学学会癫痫质量指标的依从性。在随后的一年中评估了癫痫发作频率、急诊就诊情况、受伤和死亡等临床结局。
根据我们的纳入和排除标准，共确定了169例患者：NP-医师团队护理模式队列中有65例患者，仅由医师提供护理模式队列中有104例患者。NP-医师团队护理模式每次门诊平均多看3名患者。这些队列在基线特征方面没有显著差异。NP-医师团队护理模式在癫痫质量指标方面对仅由医师提供护理模式的依从性相当，在询问副作用、提供个性化癫痫安全教育和筛查行为健康障碍的咨询措施方面依从性更高。两种护理模式在所有临床结局方面表现相似。
用于增加护理可及性的NP-医师团队护理模式也可提高所提供的护理质量。
