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A Multicenter Research on the Effects of Substitution of Hospital Ward Care From Medical Doctors to Physician Assistants

13 mei 2015 bijgewerkt door: Radboud University Medical Center

Worthy Assistants: Does Substituting Hospital Ward Care From Medical Residents to Physician Assistants Result in Cost Savings?

Reallocation of healthcare is one solution to the problems healthcare is facing. In the Netherlands reallocation of care to Physician Assistants (PAs) hasn't adequately been studied. Given the growing number of PAs, it is essential to evaluate the effectiveness and efficacy of (Dutch) PA services.

This multicenter matched-controlled study aims to evaluate the (cost) effectiveness of substitution of hospital ward care from medical doctors (MDs) to PAs. The traditional model in which the role of house officer is taken by medical doctors MD model) will be compared with a mixed model in which a PA functions as house officer together with a medical doctor (PA/MD model). Hospital wards will be matched on medical specialism and hospital type (i.e. academic;non-academic). On the basis of USA studies, it is hypothesized that the mixed PA/MD model compared to the MD model reduces the costs of healthcare, while improving or maintaining the clinical outcomes, patients and provider satisfaction, and continuity and quality of care.

Primary research question:

• What is the effect of 'mixed PA/MD model' compared with 'MD model' on efficiency of care?

Secondary research questions:

  • What is the effect of 'mixed PA/MD model' compared with 'MD model' on clinical and patients outcomes?
  • What is the effect of 'mixed PA/MD model' compared with 'MD model' on continuity of care?
  • What is the effect of 'mixed PA/MD model' compared with 'MD model' on nurses and (specialist) medicals doctor experiences?
  • What are the barriers and facilitating factors considering the implementation of PAs as house officer?

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Studietype

Observationeel

Inschrijving (Werkelijk)

2382

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Nederland
      • Utrecht, Nederland
        • UMC Utrecht
    • Drenthe
      • Emmen, Drenthe, Nederland
        • Scheper Ziekenhuis
    • Friesland
      • Heerenveen, Friesland, Nederland, 8441 PW
        • Tjongerschans Ziekenhuis
    • Gelderland
      • Apeldoorn, Gelderland, Nederland
        • Gelre Ziekenhuizen
      • Arnhem, Gelderland, Nederland, 6800 TA
        • Rijnstate
      • Doetinchem, Gelderland, Nederland
        • Slingeland Ziekenhuis
      • Ede, Gelderland, Nederland
        • Ziekenhuis de Gelderse Vallei
      • Nijmegen, Gelderland, Nederland, 6500HB
        • Radboud University Nijmegen Medical Centre
      • Nijmegen, Gelderland, Nederland, 6532 SZ
        • Canisius Wilhelmina Ziekenhuis
      • Winterswijk, Gelderland, Nederland
        • Streekziekenhuis Koningin Beatrix
    • Limburg
      • Roermond, Limburg, Nederland, 6043 CV
        • Laurentius ziekenhuis
      • Roermond, Limburg, Nederland
        • Laurentius ziekenhuis
      • Sittard, Limburg, Nederland
        • Orbis Medisch Centrum
      • Venlo, Limburg, Nederland, 5912 BL
        • VieCuri Medical Center
    • Noord-Brabant
      • Bergen op Zoom, Noord-Brabant, Nederland, 4624 VT
        • Lievensberg ziekenhuis
      • Den Bosch, Noord-Brabant, Nederland
        • Jeroen Bosch Ziekenhuis
      • Helmond, Noord-Brabant, Nederland
        • Elkerliek Ziekenhuis
      • Roosendaal, Noord-Brabant, Nederland, 4708 AE
        • Fransiscus Ziekenhuis
      • Tilburg, Noord-Brabant, Nederland
        • St. Elisabeth Ziekenhuis
      • Tilburg, Noord-Brabant, Nederland
        • TweeSteden Ziekenhuis
    • Zeeland
      • Dirksland, Zeeland, Nederland
        • Van Weel Bethesda Ziekenhuis
    • Zuid-Holland
      • Delft, Zuid-Holland, Nederland
        • Reinier de Graaf Gasthuis
      • Den Haag, Zuid-Holland, Nederland
        • HagaZiekenhuis
      • Den Haag, Zuid-Holland, Nederland
        • Medisch Centrum Haaglanden

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Bemonsteringsmethode

Niet-waarschijnlijkheidssteekproef

Studie Bevolking

Hospital Ward Care: all patients (age 18 years or older) admitted to a hospital ward will be included in the study.

Beschrijving

Inclusion criteria:

• Wards using a mixed PA/physician model (with PA ward coverage of at least 50% of the available ward hours per week, during dayshifts on weekdays) or a physician model (daily coverage by a (specialized medical doctor)

Exclusion criteria on ward level:

  • Wards from specialty hospitals
  • Wards with only PAs in training
  • Wards with a nurse practitioner (NP) in the role of house officer (NP, NP/MD or PA/NP/MD model)
  • Pediatric and psychiatric wards, intensive care units

Exclusion criteria on patient level:

  • Terminal patients
  • Not fluent in Dutch language
  • Age < 18 years
  • Patients in daycare

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

Cohorten en interventies

Groep / Cohort
Interventie / Behandeling
MD model
Hospital wards at which ward care is provided only by Medical Doctors (MDs)
PA/MD model
Hospital wards at which ward care is provided by both Physician Assistants (PAs) and Medical Doctors (MDs)
Ander: PA/MD model
Intervention wards are hospital wards at which ward care is provided by both Physician Assistants (PAs) and Medical Doctors (MDs)

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Length of hospital stay
Tijdsspanne: Patients will be followed for the duration of hospital stay; an expected average of 6 days
The difference between date of discharge and date of admission
Patients will be followed for the duration of hospital stay; an expected average of 6 days

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Efficiency of care
Tijdsspanne: Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days
Relevant costs associated with the principal admission (length of hospital stay, resource use, consultation of health care suppliers, salaries) and costs that occurred after discharge (unplanned readmission, presentation at emergency departments, visits of general practitioner, required home care) will be calculated, considering a follow-up period from admission until 1 month after discharge. All volumes will be collected in detail at an individual patient level, primarily from medical patient records and patient and care provider questionnaires. Medical costs will be calculated by multiplying the volumes of healthcare use with corresponding unit prices, derived from the Dutch Manual for Costing Research
Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days
Quality of hospital ward care
Tijdsspanne: Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days
To estimate the quality of ward care, a set of objective indicators has been developed through literature review and clinical input from a physician panel. We have selected both clinical indicators and process indicators, with a follow-up period of maximum 1 month after discharge. Clinical indicators were based on the national set of indicators for quality of hospital care from the Dutch Health Care Inspectorate (IGZ) and consider the incidences of inhospital mortality, cardiopulmonary resuscitation, unplanned readmission, presentation at emergency department after discharge,unplanned transfer to Intensive Care Unit, development of hospital infections, pressure sore and fever, and pain scores . Process indicators are the number of days between a patients discharge and the date of written turnover to general practitioner or other hospital, and acquaintance with the patient within 24 hours after admission
Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days
Patient quality of life
Tijdsspanne: Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days. Measurements of quality of life will be performed at hospital admission, hospital discharge and 1 month after discharge
Patient experienced quality of life will be measured by the EQ-5D questionnaire. This questionnaire will be distributed at hospital admission, hospital discharge, and 1 month after discharge
Patients will be followed from hospital admission till 1 month after discharge; an expected average of 1 month and 6 days. Measurements of quality of life will be performed at hospital admission, hospital discharge and 1 month after discharge
Feasibility, barriers and facilitators
Tijdsspanne: 12 months
Semi-structured (group)interviews will be held with PAs, (specialized) medical doctors, ward nurses and heads of the departments. The interviews will cover experiences with the utilized ward model, communication between professionals, satisfaction, and barriers and facilitators related to the utilization of the 'mixed PA/MD model'. Specific attention will be paid to the role and functioning of PAs
12 months
Care provider experiences
Tijdsspanne: 12 months

Job satisfaction, subjective workload and stress reaction of PAs, (specialized) medical doctors and ward nurses will be measured by a self-administered questionnaire. Job satisfaction will be measured by an adapted version of the job satisfaction questionnaire of McCranie, stress reaction will be measured by a short version of the General Health Questionnaire (GHQ-12)

Objective workload will be measured by calculating the ratio between number of working hours at the hospital ward, and the number of patients the PA or medical doctor is responsible for.
12 months
Continuity of care
Tijdsspanne: 4 months
Continuity of care will be measured by deriving the number of rotations of PAs and medical doctors at the hospital ward from work schedules, which will be assessed during 4 weeks, spread over 4 months
4 months
Patient experiences with hospital ward care
Tijdsspanne: Patients will be followed for the duration of hospital stay; an expected average of 6 days. Measurement of patient experiences will be performed at discharge
Patient experiences with medical ward care will be assessed by a self-administered questionnaire at discharge. This questionnaire focuses on satisfaction with communication, experienced continuity of care and cooperation, and the patients view on the medical competencies of the ward care provider
Patients will be followed for the duration of hospital stay; an expected average of 6 days. Measurement of patient experiences will be performed at discharge

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Radboud University Medical Center

Medewerkers

ZonMw: The Netherlands Organisation for Health Research and Development

Onderzoekers

  • Hoofdonderzoeker: M.G.H. Laurant, PhD, IQ healthcare, UMC St Radboud

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 april 2013

Primaire voltooiing (Werkelijk)

1 mei 2015

Studie voltooiing (Werkelijk)

1 mei 2015

Studieregistratiedata

Eerst ingediend

5 april 2013

Eerst ingediend dat voldeed aan de QC-criteria

18 april 2013

Eerst geplaatst (Schatting)

19 april 2013

Updates van studierecords

Laatste update geplaatst (Schatting)

14 mei 2015

Laatste update ingediend die voldeed aan QC-criteria

13 mei 2015

Laatst geverifieerd

1 mei 2015

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Andere studie-ID-nummers

  • 80-82310-97-12094

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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