Patient Outcomes in a Pediatric Hospital Medicine Service Staffed With Physicians and Advanced Practice Providers

Abstract

A B S T R A C TOBJECTIVES: Hospitals are employing more nurse practitioners and physician assistants on inpatient pediatric units. With this study, we compared patient outcomes in high-volume inpatient diagnoses on pediatric hospital medicine services staffed by attending physician hospitalists and residents (hospitalist and resident service [HRS]) with 1 staffed by attending physician hospitalists and advanced practice providers (HAPPS). METHODS:A historical cohort study was implemented by using administrative data for patients admitted to HRS and HAPPS from 2007 to 2011 with asthma, bronchiolitis, cellulitis, and pneumonia with severity levels 1 and 2 for all-patient refined diagnosis-related groups. Length of stay, readmission, ICU transfer, and hospital charges were compared. RESULTS:After controlling for clinical, demographic, and socioeconomic differences, the average probability of discharge was 10% greater each day (event ratio [ER] 5 1.1 [1.06-1.14]) on HAPPS compared with HRS. By diagnosis, this trend persisted with asthma (ER 5 1.07 [1.02-1.12]), cellulitis (ER 5 1.2 [1.1-1.3]), and pneumonia (ER 5 1.17 [1.08-1.28]) but not for bronchiolitis (ER 5 0.99 [0.92-1.06]). Both 3-and 30-day readmissions were higher for HRS discharges with bronchiolitis (odds ratio 5 5.9 [1.3-28.6] and 2.0 [1.3-3.3], respectively) but not for the other diagnoses. Hospital charges were 13% higher for patients on HRS than HAPPS. ICU transfers did not differ statistically. CONCLUSIONS:Within the limitations of the design, HAPPS performed at least as well as HRS with respect to length of stay, readmissions, ICU transfers, and charges for 4 of the most common inpatient diagnoses with severity levels 1 to 2. Indicated in these results is that in this configuration, advanced practice providers on pediatric hospitalist services represent a viable model for other institutions to consider and test.

Ramping Up a Pediatric Hospital Medicine Advanced Practice Provider Team Rapidly

“…Additionally, residents reported better balance and nurses remarked on the efficiency of the APP team. There were no adverse patient outcomes, similar to DeWolfe and colleagues' 2019 report comparing APP and traditional teams in PHM (DeWolfe et al 2019). Given the success of this pilot, we hired four APPs, two PAs and two PNPs, to join our pediatric hospital medicine group full time.…”

PAs and NPs improve patient care and productivity in a radiology consult practice

“…The optimal use of PAs and NPs is still a subject of debate, but for many medical conditions, outcomes of care managed by PAs and NPs are comparable to the results of physician-managed care. [9][10][11][12][13][14][15] The expanded use of PAs and NPs also has reduced costs. 9,10 However, little is known about the effect of integrating them into diagnostic radiology.…”

PA job availability in primary care during 2014 and 2016

“…While there is a growing body of literature both in the U.S. and internationally that indicates APRNs and PAs can provide high-quality care, increase physician productivity, and, in some specialties, perform many of the same functions as physicians, there is little information to indicate the extent to which APRNs and PAs might displace demand for physicians. [50][51][52][53] For modeling purposes, the "high-use" scenario assumes that each additional APRN or PA beyond the supply needed to maintain current staffing patterns will ease demand for physicians in their specialty as follows: anesthesiology (60%), women's health (40%), primary care (50%), medical specialties (30%), surgery (20%), and other medical specialties (30%). The "moderateuse" scenario assumes the adjustment in physician demand is half the above amounts.…”