A COMPARISON OF THE PROCESS OF CARE BETWEEN MEDICAL DOCTORS AND NURSE PRACTITIONERS TO SELECTED OUTCOMES IN AN AMBULATORY SETTING.
Contributors: Columbia University. Teachers College.
Published: 1995
Number of pages: 91
Subjects: Health Sciences, Nursing.; Health Sciences, Health Care Management.; Health Sciences, Medicine and Surgery.
Description: The purpose of this study was to examine how nurse practitioners (NPs) and attending medical doctors (MDs) differed in the process of care they provided to a randomly assigned group of pre-school pediatric patients with asthma. The effect of differences in the process on selected outcomes, and the difference in resource use between the two groups of patients was also investigated.

The sample (n = 1148) was selected from the database of available patients at the Columbia Presbyterian Medical Center in New York who had their first visit to a practitioner in the outpatient setting during the period 1/1/88 and 12/31/94. The patients were between the ages of birth and five and were assigned to the next available provider for their first outpatient visit (NP group = 394, MD group = 754). There was no significant difference in population demographics. Subsequent visits of the patients were compared to assess for consistency in the provider delivering service over time. On return visits, less than 1/2 of each group returned for follow-up to this system after their initial visit; 60% of NP patients, 73% of MD patients returned to the provider of their initial visit.

The process of care was defined as the length of initial visit, the number, and length of subsequent visits. There was a significant difference found in each of these variables between groups.

The outcome of care was defined as the number of visits to the emergency department (ED), and the number and length of stay inpatient admissions. There was no significant difference in ED use, and MDs had a significantly higher number of inpatient admissions and length of stay.

Total resource use, an amalgam of outpatient, ED, and inpatient charges was higher for the MD group overall. Most notably, 2% of the total sample used 44% of the resources over the study period.

It was concluded that the process and outcome of care was different for the two groups while resource use was lower for the NP group. Further studies on the outcomes of ambulatory care management of chronic disease are warranted.
Notes: Source: Dissertation Abstracts International, Volume: 56-07, Section: B, page: 3690.

Thesis (ED.D.)--COLUMBIA UNIVERSITY TEACHERS COLLEGE, 1995.

School code: 0055.