Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
Outcomes-based trial of an inpatient nurse practitioner service for general medical patients
Autore:
Pioro, MH; Landefeld, CS; Brennan, PF; Daly, B; Fortinsky, RH; Kim, U; Rosenthal, GE;
Indirizzi:
Vet Adm Med Ctr, Div Gen Internal Med, Cleveland, OH 44106 USA Vet Adm MedCtr Cleveland OH USA 44106 ernal Med, Cleveland, OH 44106 USA Vet Adm Med Ctr, Inst Hlth Care Res, Cleveland, OH 44106 USA Vet Adm Med Ctr Cleveland OH USA 44106 Care Res, Cleveland, OH 44106 USA Case Western Reserve Univ, Frances Payne Bolton Sch Nursing, Cleveland, OH44106 USA Case Western Reserve Univ Cleveland OH USA 44106 , Cleveland, OH44106 USA Case Western Reserve Univ, Cleveland VA Med Ctr, Sch Med, Cleveland, OH 44106 USA Case Western Reserve Univ Cleveland OH USA 44106 Cleveland, OH 44106 USA Univ Hosp Cleveland, Cleveland, OH 44106 USA Univ Hosp Cleveland Cleveland OH USA 44106 eland, Cleveland, OH 44106 USA
Titolo Testata:
JOURNAL OF EVALUATION IN CLINICAL PRACTICE
fascicolo: 1, volume: 7, anno: 2001,
pagine: 21 - 33
SICI:
1356-1294(200102)7:1<21:OTOAIN>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
PRIMARY-CARE; HEALTH-CARE; PHYSICIAN ASSISTANTS; RAPID CHANGES; CENTERS; RESIDENTS; HOSPITALS; MIDWIVES; SYSTEM;
Keywords:
delivery of health care; hospitals (teaching); models (organizational); nurse practitioners; outcome and process assessment; quality of health care;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
57
Recensione:
Indirizzi per estratti:
Indirizzo: Rosenthal, GE Univ Iowa Hosp & Clin, Div Gen Internal Med, SE618GH,200 Hawkins Dr, Iowa City, IA 52246 USA Univ Iowa Hosp & Clin SE618GH,200 Hawkins Dr Iowa City IA USA 52246
Citazione:
M.H. Pioro et al., "Outcomes-based trial of an inpatient nurse practitioner service for general medical patients", J EVAL CL P, 7(1), 2001, pp. 21-33

Abstract

Although teaching hospitals are increasingly using nurse practitioners (NPs) to provide inpatient care, few studies have compared care delivered by NPs and housestaff or the ability of NPs to admit and manage unselected general medical patients. In a Midwest academic teaching hospital 381 patients were randomized to general medical wards staffed either by NPs and a medical director or medical housestaff, Data were obtained from medical records, interviews and hospital databases. Outcomes were compared on both an intention to treat (i.e, wards to which patients were randomized) and actual treatment (i.e. wards to which patients were admitted) basis. At admission, patients assigned randomly to NP-based care (n = 193) and housestaff care (n=188) were similar with respect to demographics, comorbidity, severity of illness and functional parameters. Outcomes at discharge and at 6 weeks after discharge were similar (P > 0.10) in the two groups, including: length of stay; charges; costs; consultations; complications; transfers to intensive care; 30-day mortality; patient assessments of care; and changes in activities of daily living, SF-36 scores and symptom severity. However, after randomization, 90 of 193 patients (47%) assigned to the NP ward were actually admitted to housestaff wards, largely because of attending physicians and NP requests. None the less, outcomes of patients admitted to NP and housestaffwards were similar (P>0.1). NP-based care can be implemented successfully in teaching hospitals and, compared to housestaff care, may be associated with similar costs and clinical and functional outcomes. However, there may be important obstacles to increasing the number of patients cared for by NPs, including physician concerns about NPs' capabilities and NPs' limited flexibility in managing varying numbers of patients and accepting off-hours admissions.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 03:19:39