Advanced Practice Nurse Outcomes 1990–2008

A Systematic Review

Robin P. Newhouse, PhD, RN, NEA-BC; Julie Stanik-Hutt, PhD, ACNP, CCNS, FAAN; Kathleen M. White, PhD, RN, NEA-BC, FAAN; Meg Johantgen, PhD, RN; Eric B. Bass, MD, MPH; George Zangaro, PhD, RN; Renee F. Wilson, MS; Lily Fountain, MS, CNM, RN; Donald M. Steinwachs, PhD; Lou Heindel, DNP, CRNA; Jonathan P. Weiner, PhD

Disclosures

Nurs Econ. 2011;29(5):230-250. 

In This Article

Nurse Practitioner Outcomes

Thirty-seven studies (14 RCTs and 23 observational studies) examined patient outcomes of care by NPs (NP care group) compared with care managed exclusively by physicians (attending physicians with or without interns, residents, and/or fellows) in all but one study. Eleven patient outcomes were summarized: patient satisfaction with provider/care, patient self-assessment of perceived health status, functional status, blood glucose, serum lipids, blood pressure, emergency department visits, hospitalization, duration of ventilation, length of stay, and mortality. The number and type of studies for each outcome will be described.

Patient satisfaction. Six studies (four RCTs) reported patient satisfaction with the provider. Studies were conducted in primary care settings with adults, and from parents of children who had undergone outpatient surgery or been admitted to the hospital after a traumatic injury. When comparing NP and MD care, there is a high level of evidence to support equivalent levels of patient satisfaction.

Self-reported perceived health. Seven studies (five RCTs) examined self-reported perceived health. The instrument used in the studies included the SF-12 or SF- 36 physical and mental function scales to rate self-reported perception of health. Studies were conducted with samples of adults cared for in a primary care setting, specialty clinic, or home care in a community setting, and patients hospitalized with general medical conditions. When comparing NP and MD care, there is a high level of evidence to support equivalent levels of self-reported patient perception of health.

Functional status. Ten studies (six RCTs) reported activities of daily living (ADL), instrumental activities of daily living (IADL), 6-minute walk test, or patient self-report.

Studies were conducted with samples of community-dwelling elders who were recently discharged from hospitals and receiving either home care or inpatient rehabilitation, adults hospitalized for general medical problems, and ambulatory patients diagnosed with HIV/AIDS. When comparing NP and MD groups, there is a high level of evidence to support equivalent patient functional status outcomes.

Glucose control. Five studies (RCTs) reported glucose control (glycosolated hemoglobin, serum glucose). Studies were conducted with samples of adults in ambulatory primary care settings. When comparing NP and MD care, there is a high level of evidence to support equivalent levels of patient glucose control.

Lipid control. Three studies (RCTs) reported lipid control. Studies were conducted with samples of adults in primary care settings. When comparing NP and MD groups, there is a high level of evidence to support better management of patient serum lipid levels by NPs.

Blood pressure. Four studies (RCTs) reported blood pressure control. Studies were conducted with samples of adults in primary care settings. When comparing NP and MD groups, there is a high level of evidence to support equivalent levels of BP control.

Emergency department (ED) or urgent care visits. Five studies (three RCTs) reported utilization outcomes through ED or urgent care visits. Studies were conducted with samples of ambulatory patients with diabetes, hypertension, dyslipidemia, asthma, and heart failure; community-dwelling elders; nursing home residents; and otherwise healthy children who had recently been seen in the ED for an emergent condition. When comparing NP and MD groups, there is a high level of evidence to support equivalent rates of ED visits.

Hospitalization. Eleven studies (three RCTs) reported the utilization outcome hospitalization. Studies were conducted with samples of adult patients with heart failure managed in ambulatory care settings, older adults receiving care in nursing homes, or patients discharged home after acute care hospitalizations (premature infants, children with asthma, adults with heart failure, and older adults with general medical conditions). When comparing NP and MD groups, there is a high level of evidence to support equivalent rates of hospitalization.

Duration of mechanical ventilation. Three studies (0 RCTs) reported duration of mechanical ventilation. Studies were conducted with samples in acute care settings with adults or low-birthweight neonates. When comparing NP and MD groups, there is a low level of evidence to support equivalent duration of mechanical ventilation.

Length of stay (LOS). Sixteen studies (two RCTs) reported patient LOS. Studies were conducted with samples in high-risk neonates, children (admitted for exacerbation of asthma, pulmonary complications of cystic fibrosis, or non-thoracic or CNS traumatic injuries), critically ill adults (requiring endotracheal intubation or tracheostomy and mechanical ventilation for respiratory failure), adults (admitted with general medical problems or for cardiovascular surgery), and older adults (admitted from home or a nursing home with general medical problems). When comparing NP and MD groups, there is a moderate level of evidence to support equivalent LOS.

Mortality. Eight studies (one RCT) reported patient mortality. Studies were conducted with samples of high-risk infants (twins, pre-term, or low birthweight), adults with acute and chronic medical conditions, older adult residents of nursing homes, and critically ill adults (diagnosed with respiratory failure, multiple-cause critical illnesses, and after complex neurosurgery). When comparing NP and MD groups, there is a high level of evidence to support equivalent mortality rates.

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