Quality of care provided by physician's extenders in Air Force primary medicine clinics
Evaluates the quality of care of physician extenders (PEs) (23 physician assistants and seven primary care nurse practitioners) in Air Force primary medicine clinics, as part of an evaluation of PEs assuming care formerly provided by physicians. PEs performed at least as well as M.D.s on 25 out of 28 nonredundant process-of-care criteria. Nurse practitioners met the M.D. standard on 14 of 19 criteria. No major differences were found in PEs' use of ancillary services (laboratory and X-ray) or orders for further care when controlling for case-mix. As expected, PEs consulted M.D.s infrequently, but more often for serious complaints and at rates similar to those found in other PE studies. The study concludes that the Air Force can deliver the same quality of care when PEs treat a sizable proportion of patients formerly treated by M.D.s.
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CONDITIONSPECIFIC CRITERIA 9
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Acute sinusitis Air Force antibiotic antibiotic prescribed Arthritis and joint Asthma Backache cholecystitis compared with physicians compliance rates condition-specific criteria Coryza criterion definite follow-up planned demonstration bases demonstration project desirable disposition actions Diabetes mellitus Dyess EKGs electrocardiograms evaluation Fracture gastroenteritis groups of providers heart diseases Heart murmur hospital Hypertension includes joint pain large number MD PA PCNP Nellis number of patients number of visits nurse practitioners ordering rates Otitis media outpatient overordering Patient Contact Record PCNPs penicillin percent pharyngitis physical therapy physician involvement physician's assistants physician's extenders physicians practitioner total practitioner types prescription problem rate of ordering Referred to MD return visits sciatica serious sign tests significant differences specific statistically significant steroid summary comparisons supervision Table three groups three provider groups throat culture ordered undesirable diagnostic actions undesirable therapeutic actions urinalysis Urinary tract infection Viral syndrome X-ray conditions x-ray ordered x-rays