Clinical trial NCT01835444: A Multicenter Research on the Effects of Substitution of Hospital Ward Care From Medical Doctors to Physician Assistants
Official title: Worthy Assistants: Does Substituting Hospital Ward Care From Medical Residents to Physician Assistants Result in Cost Savings?
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Substitution of Care
Keywords: Physician Assistant
Substitution
Hospital ward care
Secondary health care
Lead sponsor: Radboud University Medical Center
Sponsor class: OTHER
Collaborators: name: ZonMw: The Netherlands Organisation for Health Research and Development
First posted: 2013-04-19
Enrollment: 2382
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Hospital Ward Care: all patients (age 18 years or older) admitted to a hospital ward will be included in the study.

Brief summary: Reallocation of healthcare is one solution to the problems healthcare is facing. In the Netherlands reallocation of care to Physician Assistants (PAs) hasn't adequately been studied. Given the growing number of PAs, it is essential to evaluate the effectiveness and efficacy of (Dutch) PA services.

This multicenter matched-controlled study aims to evaluate the (cost) effectiveness of substitution of hospital ward care from medical doctors (MDs) to PAs. The traditional model in which the role of house officer is taken by medical doctors MD model) will be compared with a mixed model in which a PA functions as house officer together with a medical doctor (PA/MD model). Hospital wards will be matched on medical specialism and hospital type (i.e. academic;non-academic). On the basis of USA studies, it is hypothesized that the mixed PA/MD model compared to the MD model reduces the costs of healthcare, while improving or maintaining the clinical outcomes, patients and provider satisfaction, and continuity and quality of care.

Primary research question:

• What is the effect of 'mixed PA/MD model' compared with 'MD model' on efficiency of care?

Secondary research questions:

* What is the effect of 'mixed PA/MD model' compared with 'MD model' on clinical and patients outcomes?
* What is the effect of 'mixed PA/MD model' compared with 'MD model' on continuity of care?
* What is the effect of 'mixed PA/MD model' compared with 'MD model' on nurses and (specialist) medicals doctor experiences?
* What are the barriers and facilitating factors considering the implementation of PAs as house officer?


Eligibility criteria: Inclusion criteria:

• Wards using a mixed PA/physician model (with PA ward coverage of at least 50% of the available ward hours per week, during dayshifts on weekdays) or a physician model (daily coverage by a (specialized medical doctor)

Exclusion criteria on ward level:

* Wards from specialty hospitals
* Wards with only PAs in training
* Wards with a nurse practitioner (NP) in the role of house officer (NP, NP/MD or PA/NP/MD model)
* Pediatric and psychiatric wards, intensive care units

Exclusion criteria on patient level:

* Terminal patients
* Not fluent in Dutch language
* Age \< 18 years
* Patients in daycare

Primary outcomes:
measure: Length of hospital stay
timeFrame: Patients will be followed for the duration of hospital stay; an expected average of 6 days
Secondary outcomes:
measure: Efficiency of care
timeFrame: Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days
measure: Quality of hospital ward care
timeFrame: Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days
measure: Patient quality of life
timeFrame: Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days. Measurements of quality of life will be performed at hospital admission, hospital discharge and 1 month after discharge
measure: Feasibility, barriers and facilitators
timeFrame: 12 months
measure: Care provider experiences
timeFrame: 12 months
measure: Continuity of care
timeFrame: 4 months
measure: Patient experiences with hospital ward care
timeFrame: Patients will be followed for the duration of hospital stay; an expected average of 6 days. Measurement of patient experiences will be performed at discharge
Other outcomes:
Locations:
city: Emmen
country: Netherlands
facility: Scheper Ziekenhuis
state: Drenthe
city: Heerenveen
country: Netherlands
facility: Tjongerschans ziekenhuis
state: Friesland
city: Apeldoorn
country: Netherlands
facility: Gelre Ziekenhuizen
state: Gelderland
city: Arnhem
country: Netherlands
facility: Rijnstate
state: Gelderland
city: Doetinchem
country: Netherlands
facility: Slingeland Ziekenhuis
state: Gelderland
city: Ede
country: Netherlands
facility: Ziekenhuis de Gelderse Vallei
state: Gelderland
city: Nijmegen
country: Netherlands
facility: Radboud University Nijmegen Medical Centre
state: Gelderland
city: Nijmegen
country: Netherlands
facility: Canisius Wilhelmina ziekenhuis
state: Gelderland
city: Winterswijk
country: Netherlands
facility: Streekziekenhuis Koningin Beatrix
state: Gelderland
city: Roermond
country: Netherlands
facility: Laurentius Ziekenhuis
state: Limburg
city: Roermond
country: Netherlands
facility: Laurentius Ziekenhuis
state: Limburg
city: Sittard
country: Netherlands
facility: Orbis Medisch Centrum
state: Limburg
city: Venlo
country: Netherlands
facility: VieCuri Medical Center
state: Limburg
city: Bergen op Zoom
country: Netherlands
facility: Lievensberg Ziekenhuis
state: Noord-Brabant
city: Den Bosch
country: Netherlands
facility: Jeroen Bosch Ziekenhuis
state: Noord-Brabant
city: Helmond
country: Netherlands
facility: Elkerliek ziekenhuis
state: Noord-Brabant
city: Roosendaal
country: Netherlands
facility: Fransiscus Ziekenhuis
state: Noord-Brabant
city: Tilburg
country: Netherlands
facility: St. Elisabeth Ziekenhuis
state: Noord-Brabant
city: Tilburg
country: Netherlands
facility: TweeSteden Ziekenhuis
state: Noord-Brabant
city: Dirksland
country: Netherlands
facility: Van Weel Bethesda Ziekenhuis
state: Zeeland
city: Delft
country: Netherlands
facility: Reinier de Graaf Gasthuis
state: Zuid-Holland
city: Den Haag
country: Netherlands
facility: HagaZiekenhuis
state: Zuid-Holland
city: Den Haag
country: Netherlands
facility: Medisch Centrum Haaglanden
state: Zuid-Holland
city: Utrecht
country: Netherlands
facility: UMC Utrecht
Study officials:
affiliation: IQ healthcare, UMC St Radboud
name: M.G.H. Laurant, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Timmermans MJC, van Vught AJAH, Peters YAS, Meermans G, Peute JGM, Postma CT, Smit PC, Verdaasdonk E, de Vries Reilingh TS, Wensing M, Laurant MGH. The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study. PLoS One. 2017 Aug 9;12(8):e0178212. doi: 10.1371/journal.pone.0178212. eCollection 2017.
citation: Timmermans MJC, van den Brink GT, van Vught AJAH, Adang E, van Berlo CLH, Boxtel KV, Braunius WW, Janssen L, Venema A, van den Wildenberg FJ, Wensing M, Laurant MGH. The involvement of physician assistants in inpatient care in hospitals in the Netherlands: a cost-effectiveness analysis. BMJ Open. 2017 Jul 10;7(7):e016405. doi: 10.1136/bmjopen-2017-016405.
citation: Timmermans MJ, van Vught AJ, Van den Berg M, Ponfoort ED, Riemens F, van Unen J, Wobbes T, Wensing M, Laurant MG. Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands. J Eval Clin Pract. 2016 Jun;22(3):395-402. doi: 10.1111/jep.12499. Epub 2015 Dec 23.
citation: Timmermans MJ, van Vught AJ, Wensing M, Laurant MG. The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol. BMC Health Serv Res. 2014 Jan 28;14:43. doi: 10.1186/1472-6963-14-43.