Use of midlevel practitioners to achieve labor cost savings in the primary care practice of an MCO

Health Services Research

Volumn 39, Issue 3, 2004, Pages 607-626

  Roblin, Douglas W ^a   Howard, David H ^b   Becker, Edmund R ^b   Adams, E Kathleen ^b   Roberts, Melissa H ^a  

^a KAISER PERMANENTE   (United States)

^b EMORY UNIVERSITY   (United States)

Author keywords

Costs of care; Managed care; Midlevel practitioners; Primary care

Indexed keywords

ACUTE DISEASE; ADOLESCENT; ADULT; AGE DISTRIBUTION; AGED; ARTICLE; CHILD; CONSULTATION; CONTROLLED STUDY; COST BENEFIT ANALYSIS; COST CONTROL; COST EFFECTIVENESS ANALYSIS; FEMALE; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH ECONOMICS; HEALTH PRACTITIONER; HUMAN; INFANT; LOGISTIC REGRESSION ANALYSIS; MAJOR CLINICAL STUDY; MALE; MANAGED CARE ORGANIZATION; NURSE PRACTITIONER; PHYSICIAN ASSISTANT; PRIMARY MEDICAL CARE; WORKMAN COMPENSATION;

EID: 2542463071     PISSN: 00179124     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1475-6773.2004.00247.x     Document Type: Article

References (35)

1. Brown, S. A., and D. E. Grimes. 1995. "A Meta-analysis of Nurse Practitioners and Nurse Midwives in Primary Care." Nursing Research 44 (6): 332-9.
2. Butler, C. C., M. Rees, P. Kinnersley, S. Rollnick, and K. Hood. 2001. "A Case Study of Nurse Management of Upper Respiratory Tract Infections in General Practice." Journal of Advanced Nursing 33 (3): 328-33.
3. Cox, C., and M. Jones. 2000. "An Evaluation of the Management of Patients with Sore Throats by Practice Nurses and GPs." British Journal of General Practice 50 (460): 872-6.
4. Crandall, L. A., W. P. Santulli M. L. Radelet, K. E. Kilpatrick and D. E. Lewis. 1984. "Physician Assistants in Primary Care: Patient Assignment and Task Delegation." Medical Care 22 (3): 268-82.
5. Druss, B. G., S. C. Marcus, M. Olfson, T. Tanielian, and H. A. Pincus. 2003. "Trends in Care by Nonphysician Clinicians in the United States." Journal of the American Medical Association 348 (2): 130-7.
6. Flood, A. B., A. M. Fremont, K. Jin, D. M. Bott, J. Ding, and R. C. Parkerjr. 1998. "How Do HMOs Achieve Savings? The Effectiveness of One Organization's Strategies." Health Services Research 33 (1): 79-99.
7. Fottler, M. D. 1979. "Physician Attitudes toward Physician Extenders: A Comparison of Nurse Practitioners and Physician Assistants." Medical Care 17 (5): 536-49.
8. Frampton, J., and J. S. Wall. 1994. "Exploring the Use of NPs and PAs in Primary Care." HMO Practice 8 (4): 165-70.
9. Freeborn, D. K., and R. S. Hooker. 1995. "Satisfaction of Physician Assistants and Other Nonphysician Providers in a Managed Care Setting." Public Health Reports 110 (6): 714-9.
10. Greenfield, S., A. L. Komaroff, T. M. Pass, H. Anderson, and S. Nessim. 1978. "Efficiency and Cost of Primary Care by Nurses and Physician Assistants." New England Journal of Medicine 298 (6): 305-9.
11. Grumbach, K., and J. Coffman. 1998. "Physicians and Nonphysician Clinicians: Complements or Competitors?" Editorial. Journal of the American Medical Association 280 (9): 825-6.
12. Grzybicki, D. M., P. J. Sullivan, J. M. Oppy, A.-M. Bethke, and S. Raab. 2002. "The Economic Benefit for Family/General Practices Employing Physician Assistants." American Journal of Managed Care 8 (7): 613-20.
13. Hemani, A., D. A. Rastegar, C. Hill, and M. S. al-Ibrahim. 1999. "A Comparison of Resource Utilization in Nurse Practitioners and Physicians." Effective Clinical Practice 2 (6): 258-65.
14. Hershey, J. C., and D. H. Kropp. 1979. "A Re-appraisal of the Productivity Potential and Economic Benefits of Physician's Assistants." Medical Care 17 (6): 592-606.
15. Holmes, G., G. Livingston, and E. Mills. 1976. "Contribution of a Nurse Clinician to Office Practice Productivity: Comparison of Two Solo Primary Care Practices." Health Services Research 11 (1): 21-33.
16. Hooker, R. S. 2002. "A Cost Analysis of Physician Assistants in Primary Care."Journal of the American Academy of Physician Assistants 15 (11): 39-42, 45, 48 passim.
17. Hooker, R. S., and D. K. Freeborn. 1991. "Use of Physician Assistants in a Managed Health Care System." Public Health Reports 106 (1): 90-4.
18. Hooker, R. S., and L. F. McCaig. 2001. "Use of Physician Assistants and Nurse Practitioners in Primary Care." Health Affairs 20 (4): 231-8.
19. Horrocks, S., E. Anderson, and C. Salisbury. 2002. "Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors." British Medical Journal 324 (7341): 819-23.
20. Hosmer, D. W., and S. Lemeshow. 1989. Applied Logistic Regression. New York: Wiley.
21. Kassirer, J. P. 1994. "What Role for Nurse Practitioners In Primary Care?" Editorial. New England Journal of Medicine 330 (3): 204-5.
22. Kinnersley, P., E. Anderson, K. Parry, J. Clement, L. Archard, P. Turton, A. Stainthorpe, A. Fraser, C. C. Butler, and C. Rogers. 2000. "Randomised Controlled Trial of Nurse Practitioner versus General Practitioner Care for Patients Requesting 'Same Day' Consultations in Primary Care." British Medical Journal 320 (7241): 1043-8.
23. LeRoy, L. 1981. The Costs and Effectiveness of Nurse Practitioners: OTA Case Studies of Medical Technologies, no. 16. Washington, DC: Office of Technology Assessment.
24. Mundinger, M. O. 1994. "Advanced-Practice Nursing: Good Medicine for Physicians? [Sounding Board]. " New England Journal of Medicine 330 (3): 211-4.
25. Rabin, D. L., and K. K. Spector. 1980. "Delegation Potential of Primary Care Visits by Physician Assistants, Medex and Primex." Medical Care 18 (11): 1114-25.
26. Rasbash, J., W. Browne, H. Goldstein, M. Yang, J. Plewis, M. Healy, G. Woodhouse, D. Draper, I. Langford, and T. Lewis. 2000. MLWin (version 1.1). London: Institute of Education, University of London.
27. SAS Institute. 2001. SAS/STAT statistical software (version 8.2). Cary, NC: SAS Institute.
28. Scheffler, R. M., N. J. Waitzman, and J. M. Hillman. 1996. "The Productivity of Physician Assistants and Nurse Practitioners and Health Work Force Policy in the Era or Managed Health Care."Journal of Allied Health 25 (3): 207-17.
29. Shum, C., A. Humphreys, D. Wheeler, M. A. Cochrane, S. Skoda, and S. Clement. 2000. "Nurse Management of Patients with Minor Illnesses in General Practice: Multicentre, Randomized Controlled Trial." British Medical Journal 320 (7241): 1038-43.
30. Sox, H. C. Jr. 1979. "Quality of Patient Care by Nurse Practitioners and Physician's Assistants: A Ten-Year Perspective." Annals of Internal Medicine 91 (3): 459-68.
31. Spector, R., P. McGrath, J. Alpert, P. Cohen, and H. Aikins. 1975. "Medical Care by Nurses in an Internal Medicine Clinic: Analysis of Quality and Its Cost."Journal of the American Medical Association 232 (12): 1234-7.
32. Spitzer, W. O., D. L. Sackett, J. C. Sibley, R. S. Roberts, M. Gent, D. J. Kergin, B. C. Hackett, and A. Olynich. 1974. "The Burlington Randomized Trial of the Nurse Practitioner." New England Journal of Medicine 290 (5): 251-6.
33. St. Peter, R.F, M. C. Reed, P. Kemper, and D. Blumenthal. 1999. "Changes in the Scope of Care Provided by Primary Care Physicians." New England Journal of Medicine 341 (26): 1980-5.
34. Venning, P., A. Durie, M. Roland, C. Roberts, and B. Leese. 2000. "Randomized Controlled Trial Comparing Cost Effectiveness of General Practitioners and Nurse Practitioners in Primary Care." British Medical Journal 320 (7241): 1048-53.
35. Yarnall, K. S., K. I. Pollak, T. Østbye, K. M. Krause, and J. L. Michener. 2003. "Primary Care: Is There Enough Time for Prevention?" American Journal of Public Health 93 (4): 635-41.