scholarly journals Information needs of generalists and specialists using online best-practice algorithms to answer clinical questions

2017 ◽  
Vol 24 (4) ◽  
pp. 754-761 ◽  
Author(s):  
David A Cook ◽  
Kristi J Sorensen ◽  
Jane A Linderbaum ◽  
Laurie J Pencille ◽  
Deborah J Rhodes
Keyword(s):  
Nurse Practitioners ◽  
Information Needs ◽  
Best Practice ◽  
Physician Assistants ◽  
Learning Opportunities ◽  
Process Models ◽  
Care Process ◽  
Provider Type ◽  
Resident Physicians ◽  
Current Guidelines

Abstract Objective: To better understand clinician information needs and learning opportunities by exploring the use of best-practice algorithms across different training levels and specialties. Methods: We developed interactive online algorithms (care process models [CPMs]) that integrate current guidelines, recent evidence, and local expertise to represent cross-disciplinary best practices for managing clinical problems. We reviewed CPM usage logs from January 2014 to June 2015 and compared usage across specialty and provider type. Results: During the study period, 4009 clinicians (2014 physicians in practice, 1117 resident physicians, and 878 nurse practitioners/physician assistants [NP/PAs]) viewed 140 CPMs a total of 81 764 times. Usage varied from 1 to 809 views per person, and from 9 to 4615 views per CPM. Residents and NP/PAs viewed CPMs more often than practicing physicians. Among 2742 users with known specialties, generalists (N = 1397) used CPMs more often (mean 31.8, median 7 views) than specialists (N = 1345; mean 6.8, median 2; P < .0001). The topics used by specialists largely aligned with topics within their specialties. The top 20% of available CPMs (28/140) collectively accounted for 61% of uses. In all, 2106 clinicians (52%) returned to the same CPM more than once (average 7.8 views per topic; median 4, maximum 195). Generalists revisited topics more often than specialists (mean 8.8 vs 5.1 views per topic; P < .0001). Conclusions: CPM usage varied widely across topics, specialties, and individual clinicians. Frequently viewed and recurrently viewed topics might warrant special attention. Specialists usually view topics within their specialty and may have unique information needs.

scholarly journals Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus

2017 ◽  
Vol 54 ◽  
pp. 004695801771276 ◽  
Author(s):  
Perri Morgan ◽  
Christine M. Everett ◽  
Valerie A. Smith ◽  
Sandra Woolson ◽  
David Edelman ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Provider ◽  
Primary Care Provider ◽  
Social Complexity ◽  
State Level ◽  
Physician Assistants ◽  
Provider Type ◽  
Electronic Health Record Data ◽  
Type Assignment

Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines whether medical and social complexity of patients is associated with whether their primary care provider (PCP) type is a physician, NP, or PA. In this national retrospective cohort study, we use 2012-2013 national Veterans Administration (VA) electronic health record data from 374 223 veterans to examine whether PCP type is associated with patient, clinic, and state-level factors representing medical and social complexity, adjusting for all variables simultaneously using a generalized logit model. Results indicate that patients with physician PCPs are modestly more medically complex than those with NP or PA PCPs. For the group having a Diagnostic Cost Group (DCG) score >2.0 compared with the group having DCG <0.5, odds of having an NP or a PA were lower than for having a physician PCP (NP odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.79-0.88; PA OR = 0.85, CI: 0.80-0.89). Social complexity is not consistently associated with PCP type. Overall, we found minor differences in provider type assignment. This study improves on previous work by using a large national dataset that accurately ascribes the work of NPs and PAs, analyzing at the patient level, analyzing NPs and PAs separately, and addressing social as well as medical complexity. This is a requisite step toward studies that compare patient outcomes by provider type.

Physician Assistant and Nurse Practitioner Malpractice Trends

2016 ◽  
Vol 74 (5) ◽  
pp. 613-624 ◽  
Author(s):  
Douglas M. Brock ◽  
Jeffrey G. Nicholson ◽  
Roderick S. Hooker
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Error ◽  
Physician Assistant ◽  
Data Bank ◽  
Physician Assistants ◽  
Provider Type ◽  
National Practitioner Data Bank ◽  
Observation Period

Trends in malpractice awards and adverse actions (e.g., revocation of provider license) following an act or omission constituting medical error or negligence were examined. The National Practitioner Data Bank was used to compare rates of malpractice reports and adverse actions for physicians, physician assistants (PAs), and nurse practitioners (NPs). During 2005 through 2014, there ranged from 11.2 to 19.0 malpractice payment reports per 1,000 physicians, 1.4 to 2.4 per 1,000 PAs, and 1.1 to 1.4 per 1,000 NPs. Physician median payments ranged from 1.3 to 2.3 times higher than PAs or NPs. Diagnosis-related malpractice allegations varied by provider type, with physicians having significantly fewer reports (31.9%) than PAs (52.8%) or NPs (40.6%) over the observation period. Trends in malpractice payment reports may reflect policy enactments to decrease liability.

Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison

1998 ◽  
Vol 7 (4) ◽  
pp. 267-281 ◽  
Author(s):  
EB Rudy ◽  
LJ Davidson ◽  
B Daly ◽  
JM Clochesy ◽  
S Sereika ◽  
...  
Keyword(s):  
Social History ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Active Role ◽  
Physician Assistants ◽  
Daily Activities ◽  
Invasive Procedures ◽  
Care Nurse ◽  
Resident Physicians ◽  
Period Data

BACKGROUND: Little information is available on the practice of acute care nurse practitioners and physician assistants in acute care settings. OBJECTIVES: To compare the care activities performed by acute care nurse practitioners and physician assistants and the outcomes of their patients with the care activities and patients' outcomes of resident physicians. METHODS: Sixteen acute care nurse practitioners and physician assistants and a matched group of resident physicians were studied during a 14-month period. Data on the subjects' daily activities and on patients' outcomes were collected 4 times. RESULTS: Compared with the acute care nurse practitioners and physician assistants, residents cared for patients who were older and sicker, cared for more patients, worked more hours, took a more active role in patient rounds, and spent more time in lectures and conferences. The nurse practitioners and physician assistants were more likely than the residents to discuss patients with bedside nurses and to interact with patients' families. They also spent more time in research and administrative activities. Few of the acute care nurse practitioners and physician assistants performed invasive procedures on a regular basis. Outcomes were assessed for 187 patients treated by the acute care nurse practitioners and physician assistants and for 202 patients treated by the resident physicians. Outcomes did not differ markedly for patients treated by either group. The acute care nurse practitioners and physician assistants were more likely than the residents to include patients' social history in the admission notes. CONCLUSIONS: The tasks and activities performed by acute care nurse practitioners and physician assistants are similar to those performed by resident physicians. However, residents treat patients who are sicker and older than those treated by acute care nurse practitioners and physician assistants. Patients' outcomes are similar for both groups of subjects.

Advanced Practice Providers Utilization Trends in Otolaryngology From 2012 to 2017 in the Medicare Population

2020 ◽  
pp. 019459982097118
Author(s):  
Marshall Ge ◽  
Jee-hong Kim ◽  
Stephanie Shintani Smith ◽  
Julianna Paul ◽  
Christine Park ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Access To Health Care ◽  
Physician Assistants ◽  
Cross Sectional Study ◽  
Tube Placement ◽  
Advanced Practice ◽  
Provider Type ◽  
Cross Sectional ◽  
Significant Difference ◽  
Over Time

Objective Nurse practitioners and physician assistants form a growing advanced practice provider (APP) group. We aim to analyze the trends and types of services provided by APPs in otolaryngology. Study Design Cross-sectional study. Setting Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use Files, 2012-2017. Methods The Medicare database was searched for 13 commonly used otolaryngology-specific Current Procedural Terminology ( CPT) codes, and 10 evaluation and management (E/M) codes were evaluated by provider type. Changes in code utilization were compared between physicians and APPs over time. Results From 2012 to 2017, there was a 51% increase in the number of otolaryngology APPs, compared to a 2.2% increase in physician providers. APPs increased their share of new and established patient visits from 4% to 7%d 11% to 15%, respectively. There was not a significant difference over time in number of patient visits performed annually per provider according to provider type. The increase in number of APP vs physician providers was significantly greater for every procedure except for balloon sinus dilation and tympanostomy tube placement. Conclusion Due to increasing numbers, APPs are accounting for more patient visits and procedures over time. The physician workforce and the numbers of procedures performed per physician have remained relatively stable from 2012 to 2017. Increasing complexity of patients seen and a broader range of procedures offered by work-experienced or postgraduate-trained APPs may further improve access to health care in the face of possible physician shortages.

Communication Outcomes in Audiologic Reporting

2011 ◽  
Vol 22 (04) ◽  
pp. 231-241 ◽  
Author(s):  
Virginia Ramachandran ◽  
James D. Lewis ◽  
Mahsa Mosstaghimi-Tehrani ◽  
Brad A. Stach ◽  
Kathleen L. Yaremchuk
Keyword(s):  
Health Care ◽  
Doctoral Students ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Doctoral Student ◽  
Physician Assistants ◽  
Educational Background ◽  
Care Providers ◽  
Provider Type ◽  
Improvement Program

Background: Audiologists often work collaboratively with other health professionals—particularly otolaryngology providers. Some form of written reporting of audiologic outcomes is typically the vehicle by which communication among providers occurs. Quality patient care is dependent on both accurate interpretation of outcomes and effectiveness of communication between providers. Audiologic reporting protocols tend to vary among clinics and providers, with most methods being based on preference rather than standardized definitions. Purpose: As part of an ongoing quality-improvement program, audiologic communication was reviewed by comparing written audiometric reports to descriptions of the audiometric results dictated by otolaryngology providers to evaluate the agreement of communication between provider groups. Research Design: Retrospective chart review. Study Sample: The study sample consisted of 6000 randomly selected charts from a total of 15,625 for the years 2004 and 2008 in the electronic medical record system of a large academic health-care system. Data Collection and Analysis: Audiogram reports and associated otolaryngology reports were reviewed by an audiologist and two audiology doctoral students. Communication occurred among 37 audiology providers and 39 otolaryngology providers. Data collected included rating of congruence or incongruence between reports, normal versus abnormal audiologic outcomes, and the nature of communication disparities. Data also included provider type (audiologist, audiology doctoral student, or trainee in clinical fellowship year [CFY]; otolaryngologist, otolaryngology resident, physician assistant, or nurse practitioner). Results: Incongruent results were higher among the sample of audiologic evaluations with abnormal outcomes (29.2%) compared with normal outcomes (9.5%). Of those cases rated as incongruent, differences in reporting audiometric results stemmed largely from variance in reporting of numerical values from the audiogram (20%), apparent dictation errors (10.1%), and communication of the ear tested (8.6%). Of those cases in which the interpretations of audiology providers differed from those of otolaryngology providers, incongruent results occurred in the interpretation of degree (29.4%), tympanometric results (28.2%), type of hearing loss (12.8%), acoustic reflex results (4.0%), symmetry (3.3%), and other domains (4.2%). Rates of incongruent results were similar regardless of experience level of the audiology provider (audiologist or audiology doctoral student/CFY) but differed depending on the educational background and experience of the otolaryngology provider. The highest incongruent interpretations were found among residents (32.5%), followed by otolaryngologists (25.2%) and physician assistants and nurse practitioners (21%). Conclusions: This study highlights the need for audiologists to critically evaluate the effectiveness of their communication with other health-care providers and demonstrates the need for evidence-based approaches for interpreting audiologic information and reporting audiologic information to others.

scholarly journals Analysis of Patient Handoff between Providers at a Tertiary Urban Medical Center

2021 ◽  
Vol 14 ◽  
pp. 192-196
Author(s):  
Candice Metzinger ◽  
Samer Antonios ◽  
K James Kallail ◽  
Hayrettin Okut ◽  
Rosey Zackula ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Medical Center ◽  
Hospital Medicine ◽  
Physician Assistants ◽  
Categorical Variables ◽  
Inpatient Stay ◽  
Continuous Variables ◽  
Medical Patients ◽  
Provider Type ◽  
Attending Physicians

Introduction. Few studies have quantified the total number of attending and consulting physicians involved in inpatients’ care, and no other research quantifies the total number of all providers participating in inpatients’ care. The purpose of this study was to calculate the number of attending hand-offs, the attending encounter time, and the total number of providers participating in inpatients’ care for all admitted patients at a tertiary urban medical center. Methods. The study design was an observational retrospective cohort. Subjects included pediatric and adult patients who were admitted to and discharged from Ascension Via Christi St. Francis (AVCSF) in Wichita, Kansas between November 01, 2019 and January 31, 2020. Data were abstracted from the Cerner Electronic Medical Record. Variables included: patient demographics, admitting diagnosis, diagnosis related group (DRG), admission service, and duration of inpatient stay. Provider variables abstracted included provider type and provider specialty. Categorical variables were presented as frequencies and percentages, while continuous variables were presented as means ± standard deviation. Results. The sample included information from 200 patient charts. Patients’ ages ranged from 5 to 94 years, with a mean of 61 years. Approximately 52% were female and 74.9% were admitted to a surgical service. The length of all inpatients’ stays ranged from less than 1 day to 31 days, with a mean of 4 days. Seventy-six different DRGs were recorded. The most frequent attending specialties for medical patients were hospital medicine, internal medicine, general surgery, and interventional cardiology. Consulting physicians had more patient encounters than any other healthcare provider. For all inpatients, an average of two attending physicians participated in care over the duration of their stay with a range of one to six attending physicians. There was an average of one hand-off between attending physicians. Patients had an average of five consulting physicians, two resident physicians, two physician assistants, and two nurse practitioners during a stay. There was an average of 10 total providers, with a range of one to 46 total providers participating in care. Conclusions. Understanding the provider data surrounding an inpatient stay is a foundational step in assessing the quality of the provider-inpatient encounter and potential areas for improvement. In this study, the average number of attending physicians and handoffs was reasonable; however, the total number of providers involved in care was relatively high. Assessment of staffing and scheduling requirements by hospital administration could identify areas of improvement to reduce the potential for medical error caused by multiple providers being involved in patient care.   

scholarly journals Barriers to identifying and obtaining CME: a national survey of physicians, nurse practitioners and physician assistants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maureen O’Brien Pott ◽  
Anissa S. Blanshan ◽  
Kelly M. Huneke ◽  
Barbara L. Baasch Thomas ◽  
David A. Cook
Keyword(s):  
Travel Time ◽  
Nurse Practitioners ◽  
Professional Associations ◽  
Physician Assistants ◽  
Age Group ◽  
Sources Of Information ◽  
Online Search ◽  
The Past ◽  
Online Tools ◽  
Source Of Information

Abstract Background CPD educators and CME providers would benefit from further insight regarding barriers and supports in obtaining CME, including sources of information about CME. To address this gap, we sought to explore challenges that clinicians encounter as they seek CME, and time and monetary support allotted for CME. Methods In August 2018, we surveyed licensed US clinicians (physicians, nurse practitioners, and physician assistants), sampling 100 respondents each of family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants (1895 invited, 500 [26.3%] responded). The Internet-based questionnaire addressed barriers to obtaining CME, sources of CME information, and time and monetary support for CME. Results The most often-selected barriers were expense (338/500 [68%]) and travel time (N = 286 [57%]). The source of information about CME activities most commonly selected was online search (N = 348 [70%]). Direct email, professional associations, direct mail, and journals were also each selected by > 50% of respondents. Most respondents reported receiving 1–6 days (N = 301 [60%]) and $1000–$5000 (n = 263 [53%]) per year to use in CME activities. Most (> 70%) also reported no change in time or monetary support over the past 24 months. We found few significant differences in responses across clinician type or age group. In open-ended responses, respondents suggested eight ways to enhance CME: optimize location, reduce cost, publicize effectively, offer more courses and content, allow flexibility, ensure accessibility, make content clinically relevant, and encourage application. Conclusions Clinicians report that expense and travel time are the biggest barriers to CME. Time and money support is limited, and not increasing. Online search and email are the most frequently-used sources of information about CME. Those who organize and market CME should explore options that reduce barriers of time and money, and creatively use online tools to publicize new offerings.

Comparison of nurse practitioners/physician assistants to gastroenterologists in performing flexible sigmoidoscopy

1998 ◽  
Vol 114 ◽  
pp. A698-A699 ◽  
Author(s):  
MB Wallace ◽  
KY Ho ◽  
Y Trnka ◽  
C Henderson ◽  
JA Kemp ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Flexible Sigmoidoscopy ◽  
Physician Assistants
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