The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study
et al. (2017) The impact of the implementation of
physician assistants in inpatient care: A multicenter
matched-controlled study. PLoS ONE 12(8):
e0178212. https://doi.org/10.1371/journal.
pone.0178212
The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study
Marijke J. C. Timmermans 0 1
Anneke J. A. H. van Vught 0
Yvonne A. S. Peters 0 1
Geert Meermans 0
Joseph G. M. Peute 0
Cornelis. T. Postma 0
P. Casper Smit 0
Emiel Verdaasdonk 0
Tammo S. de Vries Reilingh 0 2
Michel Wensing 0 1
Miranda G. H. Laurant 0 1
0 Editor: Pierre Moine, University of Colorado Denver , UNITED STATES
1 Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center , Nijmegen , The Netherlands , 2 Faculty of Health and Social Studies, HAN University of Applied Sciences , Nijmegen , The Netherlands , 3 Department of Orthopaedics, Bravis Hospital , Bergen op Zoom and Roosendaal , The Netherlands , 4 Department of Cardiology, VieCuri Medical Center Noord-Limburg , Venlo , The Netherlands , 5 Department of Internal Medicine, Radboud university Nijmegen medical center , Nijmegen , The Netherlands , 6 Department of Surgery, Reinier Haga Groep , Delft , The Netherlands , 7 Department of Surgery, Jeroen Bosch Hospital , `s-Hertogenbosch , The Netherlands
2 Department of Surgery, Elkerliek Hospital , Helmond , The Netherlands , 9 Department of General Practice and Health Services Research, Heidelberg University Hospital , Heidelberg , Germany
Methods
Results
Data 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).
collection and analysis, decision to publish, or
preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
Conclusions
This 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 registration
ClinicalTrials.gov Identifier: NCT01835444
Background
Medical care for admitted patients is increasingly reallocated to physician assistants (PAs),
because of an increased appreciation of continuity of care, pressure to deliver healthcare
efficiently, and local shortages of medical doctors (MDs) [1±3]. A PA is a non-physician
healthcare professional licensed to practice medicine in defined domains, with variable degrees of
professional autonomy [
4
]. PAs who are employed for medical care for admitted patients
usually work in a team compromising both PAs and MDs (i.e. residents, staff physicians or
hospitalists). Although there is a worldwide trend of an increase of PAs in the management of
hospitalized patients, evidence about the consequences of reallocating inpatient care from
MDs to PAs for healthcare outcomes is limited.
Literature suggests that PAs add to the quality and safety of care, which may overall reduce
patients' length of stay in hospitals [
1
]. The turnover of house staff is traditionally high due to
use of recent medical graduates who are planning to do fellowships and the mandatory
rotational cycles. PAs generally do not rotate and thus enhance continuity of care. Increased
provider continuity has been associated with improved patient outcomes and more positive
evaluations of medical care by patients [
5, 6
]. However, most of these continuity of care studies
did not focus on inpatient care.
Several North-American studies showed that quality and efficiency of care provided by PAs
is similar to that of MDs, with high levels of patient satisfaction [
7, 8
]. However, the majority
of these studies focused on primary care or intensive care units only. Only a few studies have
compared non-acute inpatient care delivered by a PA-based team with the care delivered by a
resident-based team [9±13]. These studies suggested similar quality of care, but results of PA
employment on length of stay (LOS) varied across the studies. All studies concerned only one
clinical discipline and thus a limited variation of patients. Given the outcomes of these studies
and their limitations, we conducted a multicenter study that included PAs providing care to
hospitalized patients including different clinical disciplines and hospitals.
Study aim
This study aimed to determine the effects of substitution of inpatient care from MDs to PAs
on patients' LOS, quality and safety of care, and patient experiences. We hypothesized that
medical care by PAs is, compared to MDs, more standardized and mor (...truncated)