Episode-Based Efficiency Comparisons for Physicians and Nurse Practitioners

Most previous studies comparing the efficiency of new health practitioners with that of physicians have used the visit as the basic unit of output. Several researchers have noted, though, that the episode is a conceptually superior output unit in several respects, although it is more complex to deal with methodologically. This study demonstrates the application of episode-based methods for comparing the efficiency of physicians with that of nurse practitioners. Data are drawn from the information system of the Columbia Medical Plan and from observations of provider time inputs. The analysis is confined to care episodes for otitis media and sore throat in the Department of Pediatrics. Results indicate that per episode costs with nurse practitioners as the initial provider are approximately 20 per cent below the costs of episodes in which physicians are the initial provider. Examination of a limited amount of data on patient-reported measures of effectiveness indicates that while nurse practitioners' care is less costly, it is not less effective. These findings are particularly interesting in light of recent doubts expressed about cost-savings from using new health practitioners, and particularly nurse practitioners, in group practice settings

Family medicine · Health care · Medical emergency · MEDLINE · Nurse practitioners · Unit (ring theory) · Emergency and Acute Care Studies · Healthcare Policy and Management · Medicine · Nursing · Nursing Roles and Practices · Psychology

• Nurse Practitioner and Physician Assistant Satellite Health Centers

  Edward F Brooks, Susan L Johnson•Medical Care•1986

  Incluir item

• A new index of utilization of ambulatory medical care

  Open Access•Fran ois B land, Fran�ois B�land et al.•Social Indicators Research•1989

  Incluir item

• Comparisons of Two Types of Nonphysician Providers Using Episode Based Data

  Open Access•Earl V Dunn, Chris A Higgins•The Journal of Rural Health•1987

  Incluir item

• The social impact of computer technology on physicians

  Open Access•James G Anderson, Stephen J Jay•ACM SIGCAS Computers and Society•1990

  Incluir item

• Nurse practitioners, learning from the USA experience

  Open Access•Sue Jordan•Health & Social Care in the…•2007

  Incluir item

• Health problems encountered by three levels of providers in a remote setting

  E V Dunn, Ellen Dunn et al.•American Journal of Public Health•1986

  Incluir item

• The Role of New Health Practitioners in a Prepaid Group Practice

  Donald M Steinwachs, Sam Shapiro et al.•Medical Care•1976

  Incluir item

• A Controlled Trial of the Impact of the Family Practice Nurse on Volume, Quality, and Cost of Rural Health Services

  Larry W Chambers, Patricia Bruce-Lockhart et al.•Medical Care•1977

  Incluir item

• A Method for Analyzing Resource Use in Ambulatory Care Settings

  Ira Moscovice•Medical Care•1977

  Incluir item

• The Role of New Health Practitioners in a Prepaid Group Practice

  David M Levine, Laura Morlock et al.•Medical Care•1976

  Incluir item

• The Effectiveness and Cost of Acute Respiratory Illness Medical Care Provided by Physicians and Algorithm-assisted Physicians?? Assistants

  Richard K Tompkins, Robert W Wood et al.•Medical Care•1977

  Incluir item