The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study

Abstract

BackgroundMedical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients’ length of stay (LOS), quality and safety of care, and patient experiences with the provided care.MethodsIn a multicenter matched-controlled study, the traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which besides MDs also PAs are employed (PA/MD model). Thirty-four wards were recruited across the Netherlands. Patients were followed from admission till one month after discharge. Primary outcome measure was patients’ LOS. Secondary outcomes concerned eleven indicators for quality and safety of inpatient care and patients’ experiences with the provided care.ResultsData on 2,307 patients from 34 hospital wards was available. The involvement of PAs was not significantly associated with LOS (β 1.20, 95%CI 0.99–1.40, p = .062). None of the indicators for quality and safety of care were different between study arms. However, the involvement of PAs was associated with better experiences of patients (β 0.49, 95% CI 0.22–0.76, p = .001).ConclusionsThis study did not find differences regarding LOS and quality of care between wards on which PAs, in collaboration with MDs, provided medical care for the admitted patients, and wards on which only MDs provided medical care. Employing PAs seems to be safe and seems to lead to better patient experiences.Trial registrationClinicalTrials.gov Identifier: NCT01835444

Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients

“…In this study, we investigated whether PAs could be a safe substitute for MRs. Besides substitution of care, PAs could perform additional tasks that were normally the responsibility of the staff physician or resident, like integrating newly employed doctors, providing education, organizing nursing multidisciplinary consultation, taking part in medical emergency teams, or conducting quality projects . We have not measured these topics in our study; however, we do believe that these topics are also relevant in ICUs.…”

“…They also perform endoscopies, catheterizations, elective cardioversion, and minor surgery. 1,[5][6][7] Physician assistant programmes lead to the award of a master's degree and are based on the medical model. that students are employed as a PA in training within a particular medical specialty while enrolled in the master's PA programme.…”

Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada

“…Multiple studies echo the importance of determining the appropriate level of regulation and funding support to fully realize the utility of PAs and to optimize their integration (4,7). In addition, the lack of policy around reimbursement and incentives means that existing payment incentive mechanisms and the legacies of past policies are driving various stakeholders to pursue divergent interests (i.e.…”

“…Physician Assistants (PAs) are advanced clinical practitioners trained in the medical model to extend physician services, and are currently employed in a wide variety of healthcare settings across a number of countries, including the United States, United Kingdom, Australia, and the Netherlands (1)(2)(3). The role of PAs may offer solutions to the inherent tensions between service demands, training requirements and budgetary restraints, compensate for cyclical health workforce shortages, provide a flexible addition to the healthcare workforce, provide team continuity, and improve patient experiences (4)(5)(6)(7). Hoping to achieve similar results in Ontario (Canada), the Ontario Ministry of Health and Long Term Care introduced PAs in 2006 as a potential health human resource innovation to improve access to care, reduce wait times, and support the complex needs of healthcare delivery in Ontario (8)(9)(10).…”

“…[PA, EM]The nature of the supervisory relationship allows PAs to learn from a variety of practitioners. There is considerable setting-dependent variability in the number of supervising physicians that work with a PA (ranged from[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. PAs are therefore exposed to a variety of practice styles, personalities, bedside manners, medical expertise and other consulting services.…”