3-year study of NPs in the ED: Worse outcomes, higher costs

Nurse practitioners delivering emergency care without physician supervision or collaboration in the Veterans Health Administration increase lengths of stay by 11% and raise 30-day preventable hospitalizations by 20% compared with emergency physicians, says a working paper published by the National Bureau of Economic Research.

That higher preventable hospitalization rate “may reflect two possibilities,” says the working paper, written by David Chan, MD, PhD, associate professor of health policy at Stanford University School of Medicine, and Yiqun Chen, PhD, assistant professor of economics at the University of Illinois at Chicago.

One is that “NPs have poorer decision-making over whom to admit to the hospital, resulting in underadmission of patients who should have been admitted and a net increase in return hospitalizations, despite NPs using longer lengths of stay to evaluate patients’ need for hospital admission.”

The other possibility is that “NPs produce lower quality of care conditional on admitting decisions, despite spending more resources on treating the patient (as measured by costs of the ED care). Both possibilities imply lower skill of NPs relative to physicians.”

My latest for the AMA. Read the whole shebang.