Quality and Cost of Inpatient Nurse Practitioner-Led Care
Abstract: To meet the growing demands of inpatient care, nurse practitioners (NPs) are increasingly taking the lead in inpatient settings. Previous studies have found that adding NPs to inpatient teams can improve outcomes and costs. Few studies, however, have examined the value of NP-led models of care. Our study is a retrospective quasi-experimental investigation that takes advantage of a natural experiment occurring at the Hospital of the University of Pennsylvania. Patients on the hematology-oncology unit are assigned, based on availability, to either NP-led care or the usual house staff service (resident/attending teams). We will compare outcomes, cost, and value (evaluated as the ratio of each outcome by cost) for patients under each model of care. Because the assignment process may lack the true controlled randomization that would occur in a clinical trial, we will also use state-of-the-art methods to carefully match patients on detailed clinical and demographic information—this will account for any residual differences in patients assigned to each service. The study aims are: 1) To determine whether there is an outcome, cost, and value advantage for patients cared for under an NP-led service versus usual house staff care; and 2) To determine whether clinical subgroups exist for which any outcome, cost, and value benefit is more pronounced for NP-led care. This information is needed to effectively target NP-led care and traditional house staff care to patients that can most benefit from each model of care, while allowing the institution to realize the greatest value for patientcentered care.