A Comparative Study of Nursing Home Resident Outcomes Between Care Provided by Nurse Practitioners/Physicians versus Physicians Only

Objectives

The objective of this study was to determine if outcomes of care for nursing home residents differ between two groups of providers: nurse practitioners/physicians and physicians only.

Design

We conducted a retrospective chart review covering the 12-month period from September 1, 1997, until August 31, 1998.

Setting

We studied eight nursing homes in central Texas.

Participants

Two hundred three residents were randomly selected who resided in one of the eight nursing homes during the specified time period.

Statistical Analysis

We used chi-squared or Fisher exact test for comparisons of percent and Student t test for comparison of means; comparisons were made with both the FREQ procedure and the univariate procedure.

Results

Acute visits were significantly higher for the nurse practitioner/physician team (3.0 ± 2.4) versus the physician-only group (1.2 ± 1.5). The nurse practitioner/physician group treated significantly more eye, ear, nose, and throat and dermatologic diagnoses than the physician-only group. Emergency department visits, emergency department costs, hospitalizations, length of stay, hospital costs, performance of mandated progress visits, and performance of annual history and physicals did not show significant differences between the two groups.

Conclusion

The level of care provided for patients by the two groups of providers was basically the same and of similar quality; however, the nurse practitioner/physician group patients were seen more often. Increased visits by nurse practitioners are assumed to result in time and cost savings for physicians and improved access to care for patients.

Keywords:  Nurse practitioners , physicians , nursing home , outcomes