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

13 maja 2015 zaktualizowane przez: 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?

Przegląd badań

Status

Zakończony

Warunki

Interwencja / Leczenie

Typ studiów

Obserwacyjny

Zapisy (Rzeczywisty)

2382

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Lokalizacje studiów

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

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

18 lat i starsze (Dorosły, Starszy dorosły)

Akceptuje zdrowych ochotników

Nie

Płeć kwalifikująca się do nauki

Wszystko

Metoda próbkowania

Próbka bez prawdopodobieństwa

Badana populacja

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

Opis

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

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

Kohorty i interwencje

Grupa / Kohorta
Interwencja / Leczenie
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)
Inny: PA/MD model
Intervention wards are hospital wards at which ward care is provided by both Physician Assistants (PAs) and Medical Doctors (MDs)

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
Length of hospital stay
Ramy czasowe: 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

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
Efficiency of care
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Sponsor

Radboud University Medical Center

Współpracownicy

ZonMw: The Netherlands Organisation for Health Research and Development

Śledczy

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

Publikacje i pomocne linki

Osoba odpowiedzialna za wprowadzenie informacji o badaniu dobrowolnie udostępnia te publikacje. Mogą one dotyczyć wszystkiego, co jest związane z badaniem.

Publikacje ogólne

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów

1 kwietnia 2013

Zakończenie podstawowe (Rzeczywisty)

1 maja 2015

Ukończenie studiów (Rzeczywisty)

1 maja 2015

Daty rejestracji na studia

Pierwszy przesłany

5 kwietnia 2013

Pierwszy przesłany, który spełnia kryteria kontroli jakości

18 kwietnia 2013

Pierwszy wysłany (Oszacować)

19 kwietnia 2013

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Oszacować)

14 maja 2015

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

13 maja 2015

Ostatnia weryfikacja

1 maja 2015

Więcej informacji

Terminy związane z tym badaniem

Słowa kluczowe

Inne numery identyfikacyjne badania

  • 80-82310-97-12094

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

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