Multiple policy implications can be drawn from these results. The evidence identified in this review supports the premise that outcomes of NP-provided care are equivalent to those of physicians. Thus the question of the comparability of NP/MD quality, safety, and effectiveness of care is answered, to a very considerable degree, by this review.
A growing number of influential groups have called for the appropriate use of all qualified providers (including NPs) to address the health care needs and improve health outcomes of Americans.[15,16,71,72] Physicians, NPs, and their respective professional organizations should use the results of this review to help initiate interprofessional discussions that could lead to better understanding of one another's roles and capabilities and, ultimately, to improved care systems in which all providers contribute to the maximum extent that their education and qualifications allow.[73–76] These conversations might also lead to greater opportunities for NPs and MDs to be educated on a cooperative interdisciplinary basis within joint medical/nursing training programs.
NPs play an increasingly important role in providing high quality patient care in the US. The results of this systematic review will help to address concerns about whether NPs can safely augment the MD supply and support health care reform efforts aimed at expanding access to the tens of millions of newly insured Americans.
An effective health system integrates the diverse knowledge and skills of multiple types of providers who communicate and collaborate with the patient and each another and are accountable to deliver coordinated care to the patient and society.[77,78] Health care professionals need to create better and more collaborative systems. Health care reform initiatives, such as patient-centered medical homes and accountable care organizations should be designed to examine these collaborative care models and to document the outcomes and effectiveness of alternative staffing models. Future evaluation studies of alternative workforce teams should differentiate among the provider models used. In this manner we can advance our knowledge base on the effectiveness of various workforce alternatives that will be found as our system undergoes transformation. Governmental, institutional, and payer policies need to accommodate these diverse models of care.
This systematic review supports previous evidence amassed over the past decade that NPs deliver high quality, safe, and effective care to a large number of patient populations in a variety of settings. NPs practicing autonomously and in partnership with MDs have a very significant role in promoting health and providing care to diverse populations in numerous settings. In this time of health care reform and system evolution, to best meet the needs of Americans, it is essential that future models of care take full advantage of the growing number of NPs to their full potential and capabilities.[72–80]
The authors acknowledge Janine Michaelson, Karen Woodson, Ritu Sharma, and Dr. Kristin Seidl for their assistance with this systematic review.
In compliance with national ethical guidelines, the authors report no relationships with business
Journal for Nurse Practitioners. 2013;9(8):492-500.e13. © 2013 Elsevier Science, Inc.