Moderator LT_Oneal_PAC Posted October 9, 2014 Moderator Share Posted October 9, 2014 More guns in their arsenal. http://www.medscape.com/viewarticle/832738 Link to comment Share on other sites More sharing options...
MedPsy82 Posted October 9, 2014 Share Posted October 9, 2014 Looks like another study funded and done by the nursing association. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 9, 2014 Author Moderator Share Posted October 9, 2014 You expect someone else to fund it? If you find a problem in their data please point it out. They are quick to note this is a correlation, not causation. Whether the study is sound aside, the point is we need our own studies. We are going to have to pay for it as well. Link to comment Share on other sites More sharing options...
MedPsy82 Posted October 9, 2014 Share Posted October 9, 2014 Other medical studies are done by third parties. I would expect something of this magnitude to be done in the same manner. Since this study was funded by the nursing association, to further the nursing association, it has too much bias in it and is therefore not a good study. I also saw no actual figures, methods, or really anything else that is included in basic scientific studies that I see. It was just an article that said a study was done and concluded that independent NP's are equivalent to physicians, which I personally think is rediculous to insinuate. Take a deep breath and calm down. There is no need to get so defensive about it. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 9, 2014 Author Moderator Share Posted October 9, 2014 Other medical studies are done by third parties. I would expect something of this magnitude to be done in the same manner. Since this study was funded by the nursing association, to further the nursing association, it has too much bias in it and is therefore not a good study. I also saw no actual figures, methods, or really anything else that is included in basic scientific studies that I see. It was just an article that said a study was done and concluded that independent NP's are equivalent to physicians, which I personally think is rediculous to insinuate. Take a deep breath and calm down. There is no need to get so defensive about it. Where do you see who paid for the study? I can only see it was done at the University of Missouri. I don't see how you can say it wasn't a valid study without seeing the data. My understanding is the study, not the article, only says that independent practice has improved outcomes. I am not upset in the least. If you read into that I was, perhaps you are the sensitive one. Link to comment Share on other sites More sharing options...
MedPsy82 Posted October 9, 2014 Share Posted October 9, 2014 ....I am not upset in the least. If you read into that I was, perhaps you are the sensitive one. This is what I mean about being defensive. Take a deep breath and relax. Good day. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 9, 2014 Author Moderator Share Posted October 9, 2014 This is what I mean about being defensive. Take a deep breath and relax. Good day. Again, I'm not. If you think that one must "take a deep breath" when having a debate, then you are reading into something not there. Link to comment Share on other sites More sharing options...
MedPsy82 Posted October 9, 2014 Share Posted October 9, 2014 The article shares that the study was published in the Nurses Outlook Journal, this is shown at the top of the article and in the Abstract linked at the end of the article. According to the abstract, what was looked at was (1) level of NP autonomy in different states (Full, Reduced, or Restricted), (2 )nationwide state level analysis of Potentially avoidable hospitalizations, readmissions after inpatient rehab, and nursing home residents hospitalizations, and (3) state health outcome rankings. There is no seen comparison between the NP's care for these patients and care given by PA's or MD/DO's. Without that exact comparison of outcomes it is unreliable to state any type of equivalence. The study does show that better results are seen in states with Full scope of practice rights for NP's, but again there is no seen evidence that this was because of the NP's level of autonomy. The results could be based on (1) employment type (some jobs are more hazardous than others, and some states have more types of certain jobs than others), (2) healthcare policies, in general, for those states, or (3) hospital utilization by the public (not everyone goes to the hospital even if they are really sick or injured), these are just a few examples as I am sure there are many more. I am unable to access the actual study, so I do not know what the parameter of the study were nor if any comparison to other healthcare providers was even looked at, it seems NP's and PA's are lumped together in many studies. This essentially means some of the studies conducted are using healthcare outcomes from PA's to prove a point, even though the outcomes were not from NP's. If anyone is able to provide the actual study I would be more than happy to look at it. On a side note, the authors were from the Sinclair School of Nursing at the University of Missouri, so of course the study would be done at that university. Link to comment Share on other sites More sharing options...
MassPA-C Posted October 9, 2014 Share Posted October 9, 2014 I spent quite a few years in quality improvement and health outcomes research before PA school. So these are a few things that I would want more information on if I was peer-reviewing this for a journal. Perhaps the the full-text article will explain as this is just an NP's interpretation of the article written by two other researchers. 1- It appears that they are looking at state level data from different years and in many cases over vastly different time periods. I would be interested in how/why they choose this approach and how the are controlling for the differences. 2-how are they defining "avoidable hospitalizations"? 3- 30 day readmission rates for same or different problem? 4- they talk about statistically improved outcomes for the 17 states that have full practice but do not explain what the other 33 states without full practice are (i.e. was there a statistical difference between the reduced practice and the full practice or vs. the restrictive practice) On the first page they define the groups into those three categories but only present data on the full vs the other two lumped together leading me to believe their was no statistical difference unless they did this. Mean the difference are small and the data has been somewhat creatively analyzed to get it to present what it says (not that researchers don't do that) BUT usually a table with Full vs Reduced and Full vs restrictive and reduced vs restrictive should be included for the sake of transparency (which it seems might be included in the full text article). Finally their "n's" are low because this is state level data, it is hard to infer much from such low n's, especially given the size difference in the two groups. Again, I would be interested to read the full-text article when it is published as it may answer some of these questions.Agree that we need to do some of our own research but one problem with that is that few PA's have research backgrounds. I know I was one of two in my program who had done serious research (NIH level) and published before PA school. Most PA schools are looking for the EMT, paramedic, etc with other patient care experience (how many times on here have I seen people arguing that research should not be considered for direct patient care). As a newly minted PA who is working in EM (I worked in EM before PA school in research) I am excited to practice but also to force my way into research in the department. When I was interviewing, I kept hearing "well we are open to PA's doing research we just never have had anyone want to do it". So in some ways I think letting a few of us research folk in the door will benefit the whole profession in the long run. Link to comment Share on other sites More sharing options...
primadonna22274 Posted October 9, 2014 Share Posted October 9, 2014 Soooo many confounders affecting these outcomes that I am skeptical to say the least. What's blatantly missing from the conclusion piece of the article is any statement about limitations of the study, possible confounding variables, etc. The association drawn between better outcomes in NH residents from full-practice states vs those in restricted-practice states is interesting but it remains an ASSOCIATION. Still, look at the other thread on this board that asks whether your patient care has suffered because you are a PA: we can all think of instances where this might be true. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 9, 2014 Author Moderator Share Posted October 9, 2014 Where it is published doesn't indicate funding. I could equally assume it was a grant from the university where the research was done. While I'm interested in reading there methods/data as well, it really isn't the point of the post. This is just one in a long line of studies done to further NPs. The major one being done by the IOM stating the same thing. While we can't just jump to studies on independent PA practice, we could do a study to show that there are better outcomes with less restrictive PA practice by utilizing the same sources of data. Link to comment Share on other sites More sharing options...
primadonna22274 Posted October 9, 2014 Share Posted October 9, 2014 ^^^yes, we could...and I hope the writing will be better too Link to comment Share on other sites More sharing options...
Timon Posted October 9, 2014 Share Posted October 9, 2014 I agree that there should be more studies to show how well PAs perform patient care (outcomes, total impact on healthcare shortage, increase of services, malpractice, etc). I did some poking around a year ago about PA outcomes and found a number of articles showing the outcomes of PAs vs Physicians and NPs. Each of them said that PAs had better outcomes than physicians and lowered malpractice risks for physicians. Here are a link to a couple of the sources I found but I think they were siting the same 17 year study that was done in 2009: Costs The study found that the cost of malpractice payments in 2008 dollars exceeded $74 billion dollars in the period from 1991-2007 for PAs, APNs and physicians alone. This does not include all other health care providers such as dentists, podiatrists, optometrists, pharmacists, and chiropractors. Of this $74 billion, only $245 million were PA malpractice payments. Malpractice Incidence Over the 17 year study period, there was one malpractice payment for every 32.5 PAs while there was one for every 2.7 physicians. http://www.hgexperts.com/article.asp?id=5878 "Seventeen years of observation suggest that, if anything, PAs and NPs may decrease liability, at least as viewed through the lens of a national reporting system," the authors wrote. "During that period, there was 1 payment for every 2.7 active physicians, 1 for every 32.5 active PAs and one for every 65.8 active and inactive advance practice nurses. In percentage terms, 37% of physicians, 3.1% of PAs and at least 1.5% of APNs [advance practice nurses] would have made a malpractice payment. The physicians mean payment was 1.7 times higher than PAs and 0.9 times that of APNs, suggesting that PA employment may be a cost savings for the health care industry along with the safety of patients." http://www.medscape.com/viewarticle/775746_2 Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 9, 2014 Moderator Share Posted October 9, 2014 Where it is published doesn't indicate funding. I could equally assume it was a grant from the university where the research was done. While I'm interested in reading there methods/data as well, it really isn't the point of the post. This is just one in a long line of studies done to further NPs. The major one being done by the IOM stating the same thing. While we can't just jump to studies on independent PA practice, we could do a study to show that there are better outcomes with less restrictive PA practice by utilizing the same sources of data. I believe PAFT is looking into such a study... Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 9, 2014 Author Moderator Share Posted October 9, 2014 I believe PAFT is looking into such a study... Which why I give them my money! Link to comment Share on other sites More sharing options...
SocialMedicine Posted October 9, 2014 Share Posted October 9, 2014 there is a reason this was published in nursing outlook and nobody that matters is discussing it. Link to comment Share on other sites More sharing options...
primadonna22274 Posted October 9, 2014 Share Posted October 9, 2014 Except that it ended on on Medscape IIRC Link to comment Share on other sites More sharing options...
FingersCrossed Posted October 9, 2014 Share Posted October 9, 2014 Link to comment Share on other sites More sharing options...
gbrothers98 Posted October 9, 2014 Share Posted October 9, 2014 there is a reason this was published in nursing outlook and nobody that matters is discussing it. Haha That is true, till someone in the media on a slow day picks it up and rebroadcasts it indiscriminately without an eye towards sources, disclosures, statistics or anything based upon scientific and rationale interpretation. A great example is the study that was done by a group of Mayo internists bashing referrals from PAs and NPs in their catchment area. I have seen 2 other articles that have quoted this study and it has been discussed on this forum. Either of these articles can gain traction and with addition of local, regional and national news attention, greatly affect perception and attitude. There is a quote: History is written by the victors.... The reality is that history is written both prior and after the victory, call it propaganda, winning hearts and minds, whatever. The nursing lobby is actively pursuing their agenda...no physician oversight for NPs in every state, period. They are effectively using their political clout and will to position NPs as a discrete worthwhile solution to many of healthcare's ills both involving patients and the system in general. Have to give them credit concerning the proactivity, the vision and foresight being exhibited. They are all in. G Brothers PA-C Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 9, 2014 Moderator Share Posted October 9, 2014 Even a bad study with good outcomes can be used on the hill to effect policy.... yup back on the bandwagon that we need political advancement and a DA (Dumb A**) politician in DC doesn't know how to interpret (sorry my personal bias comes in here) the value of data and rather a study is any good - they just hear that NP's are better to independent----- Hence ANA stands up to the garbage that AMA spews about the fact every care decision needs to be lead by a PHYSICIAN lead team. (sorry Prima) Is this a good research study? I have no idea.... Will NPs use it to lobby and push for more independence..... I bet yes We don't need the perfect study to prove we are as good as the doc's - we need any study that we can use to push our case.....can't be garbage but we need something...... Institute of Medicine would be great..... As the saying goes - "put up or shut up" so..... I choose to put up - I will donate $200 to PAFT to start the campaign to fund an IOM study on PAs Anyone else care to join in ????? Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 9, 2014 Moderator Share Posted October 9, 2014 Impact of Nurse Practitioners on Health Outcomes of Medicare and Medicaid Patients Oliver GM, Pennington L, Revelle S, Rantz M Nurs Outlook. 2014 Aug 1. [Epub ahead of print] Nurse Practitioner Level of PracticeThere is a need to address the high costs and often poor quality of healthcare in the United States. Many studies show that nurse practitioners (NPs) provide safe and high-quality care when compared with other healthcare providers. Yet there are different levels of NP practice in this country as a result of the differences in state licensing laws. Some states have restrictive practices, whereas others allow full scope or independent practice for NPs. In this study, the researchers analyzed data to determine the impact that level of practice (full, reduced, or restricted) of NPs in the United States has on the outcomes of Medicare and Medicaid patients, focusing on avoidable hospitalizations, readmission rates, nursing home resident hospitalizations, and health outcome rankings. Vaccinate your preteen patients Learn more Information from Industry Full practice was defined as absolute independent practice in which the NP is responsible exclusively to a state board of nursing. Reduced practice was defined as a collaborative practice agreement with a physician specifying the scope of practice allowed. Restricted practices were those that required a physician to oversee all care provided by the NP. Oliver and colleagues obtained data from the Centers for Medicare and Medicaid Services (CMS) and other organizations that had data ranked by state; health outcomes were then studied. Potentially avoidable hospitalizations for Medicare and Medicaid beneficiaries were reviewed from 2007 to 2009. Thirty-day rates of readmission to hospitals from post-acute rehabilitation were reviewed from 2006 to 2011. Nursing home resident hospitalizations were reviewed from fiscal year 2011. Finally, health outcome rankings by the state were obtained from the United Health Foundation report on America's 2012 health rankings. Study Findings Help protect 11- or 12-year-old female and male patients Find out why it's important to vaccinate prior to exposure Information from Industry Statistically significant improved outcomes were found in all 4 areas in states with full practice (n=17) compared with states without full practice (n=33). Potentially avoidable hospitalizations for Medicare and Medicaid beneficiaries were 100/1000 person-years in the full practice states compared with 146/1000 person-years in the states without full practice. Thirty-day hospital readmissions after discharge from rehabilitation were 10.46 in the full practice group and 11.68 in the states without full practice. Annual hospitalization of nursing home patients averaged 18.1 in full-practice states vs. 25.9 in states without full practice. Overall health outcomes (with lower numbers corresponding to better outcomes) averaged 17 in the full-practice states and 30 in the states without full practice. When compared individually with either reduced or restricted practice, full-practice states had statistically significantly better outcomes in all 4 areas compared with either of the limited practice states. The investigators point out that these are associations and that causality cannot be confirmed, but these outcomes should be examined closely and should be an impetus for further changes in public policy to ensure that NPs have full practice across the country. ViewpointNP scope of practice varies by state in this country. Each state board of nursing determines how independent or restricted NP practice will be. Politics, rather than logic, often influences this determination. For example, several years ago I practiced as an NP in the state of Missouri. In Missouri, there were nurses, pharmacists, and physicians on the board that licensed NPs. I was required to practice under the supervision of a licensed physician. I could only practice in an office on my own if a physician was available within a 30-mile radius of my location. Prescribing any controlled substance was not permitted. Later, I moved to the state of Maine. In Maine, I am licensed independently and practice independently, without the requirement of any supervision. Now I am permitted to prescribe schedule II-V controlled substances without supervision. Maine, which had only nurses regulating NPs on its licensing board, doesn't restrict NP practice. Did my competency or my skills change with the move to Maine? Am I more knowledgeable or able to provide better clinical care in Maine? Absolutely not! I was the same NP I had been in Missouri. The change was in the rules of the state. The Institute of Medicine issued a report 3 years ago titled, "The Future of Nursing: Leading Change, Advancing Health."[1]A key recommendation in this report was to remove scope-of-practice barriers for advanced practice registered nurses (APRNs). The Federal Trade Commission also raised the question of the legitimacy of barriers to APRN practice in a recent report.[2] They stated that removing barriers that limit full scope of practice for NPs will improve access and quality of healthcare. Vaccinate your preteen patients Learn more Information from Industry This study looks at how full scope of NP practice might improve health outcomes and health status. Comparing outcome data from states that have full scope of practice with those permitting only limited scope of practice, Oliver and colleagues found significantly fewer avoidable hospitalizations, readmissions after discharge from rehabilitation, and nursing home resident hospitalizations. States with full scope of practice also had higher health outcome rankings than states with limited scope of practice for NPs. Are the barriers to full practice affecting access, cost, and outcomes of care? Although these data show an association or relationship, and not cause and effect, they merit some attention. The barriers to practice that result in reduced or restricted practice of NPs are allegedly to protect the public, yet the research has shown NP care to be equal to that of physicians.[3-5] In some studies, patients preferred care by NPs over physicians. This study echoes the calls from the Institute of Medicine, the Federal Trade Commission, and numerous publications that support removal of barriers to the full scope of practice for NPs, saying that supervision and collaborative practice add to the burden of providing care without any gains in quality or lowering of the cost of care. Independent practice for NPs has proven to result in safe, high-quality, compassionate, and cost-effective care. Nurs Outlook. 2014 Aug 1. pii: S0029-6554(14)00150-X. doi: 10.1016/j.outlook.2014.07.004. [Epub ahead of print] Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Oliver GM1, Pennington L1, Revelle S2, Rantz M3. Author information Abstract Strengthening health care overall is essential to the health of our nation and promoting access to health care as well as controlling health care costs in a quality cost-effective manner. Nurse practitioners have demonstrated to be effective and cost-effective providers in prior research; however, many states restrict their practice. We examined for a statistically significant relationship between the level of advanced practice registered nurse (APRN) practice (full, reduced, or restricted) allowed and results of recent nationwide, state level analyses of Medicare or Medicare-Medicaid beneficiaries of potentially avoidable hospitalizations, readmission rates after inpatient rehabilitation, and nursing home resident hospitalizations and then compared them with state health outcome rankings. States with full practice of nurse practitioners have lower hospitalization rates in all examined groups and improved health outcomes in their communities. Results indicate that obstacles to full scope of APRN practice have the potential to negatively impact our nation's health. Action should be taken to remove barriers to APRN practice. Copyright © 2014 Elsevier Inc. All rights reserved. KEYWORDS:Medicaid; Medicare; Nurse practitioners PMID: 25172368 [PubMed - as supplied by publisher] Share on Facebook Share on Twitter Share on Google+ Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 9, 2014 Moderator Share Posted October 9, 2014 As the saying goes - "put up or shut up" so..... I choose to put up - I will donate $200 to PAFT to start the campaign to fund an IOM study on PAs Anyone else care to join in ????? already done. as a founding board member I contributed "significantly" to the formation of the organization. Link to comment Share on other sites More sharing options...
FingersCrossed Posted October 10, 2014 Share Posted October 10, 2014 Just posted: A new AAPA study conducted by Harris Poll confirms that patients believe PAs add value to healthcare teams and provide excellent patient service.Among an oversample of 680 Americans who have interacted with a PA in the last year, 93 percent agree PAs are going to be part of the solution to address the shortage of healthcare providers.See the full results of the study: http://bit.ly/1ycfkMA Link to comment Share on other sites More sharing options...
Acromion Posted October 10, 2014 Share Posted October 10, 2014 Hey guess what, did ya know that the per capita consumption of mozzarella cheese correlates almost exactly with the number of civil engineering doctorates awarded? Check it out: http://www.tylervigen.com/view_correlation?id=3890 We should start encouraging people to eat more mozzarella because then we would have more civil engineers. Examining the AANP's scope of practice map, one can easily see that the "full practice" states weigh heavily towards the states with the healthiest populations: Pacific NW, Minnesota, Iowa and the far Northeast. The restricted or reduced practice states are mostly in the south / southwest, i.e. the "stroke belt." There's no attempt in the study to control for variables such as population health. http://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment Ah well, it's a junk study in Nurse Outlook. It wouldn't even be considered in a real public health journal. Link to comment Share on other sites More sharing options...
UpRegulated Posted October 11, 2014 Share Posted October 11, 2014 Hey guess what, did ya know that the per capita consumption of mozzarella cheese correlates almost exactly with the number of civil engineering doctorates awarded? Ah well, it's a junk study in Nurse Outlook. It wouldn't even be considered in a real public health journal. I really don't understand a few that post on this board. Everyone knows that correlation doesn't = causation. Increased ice cream consumption is correlated with increased shark attacks on surfers. The "cause" to both is obviously is warm weather. Who doesn't understand that? What I don't get is that some of you guys/gals don't get that these NP studies can be used to further your own cause (I'm an NP student). You think your training is better. Fine, let's assume for the sake of argument that it is. What you should be doing (as PA's) is arguing that studies have shown that NP's do as well as MD's, and that PA training is even better than what NP's receive, therefore PA's should enjoy the autonomy/independence that NP's have. Instead, you dog NP studies as biased. They may very well be, but who the heck else is going to study NP (or PA) efficacy? The AMA? That would be biased too, and it is telling to me that there are no AMA/MD/DO studies to refute what NP's are saying. Why????? As a PA, you should be taking advantage of NP studies that show that NPP's can have outcomes as good as MD/DO's, biased or not. Instead, you ridicule them. That does not further your cause. Your war is not with NP's - it is with physicians. Do you, as a PA, think your care is a good as what a physician can offer? Of course you do. So play the game. So what that these are "flawed" NP studies. Use them to your advantage. Use them to promote your profession. Attacking NP studies only hurts you...as a PA. Link to comment Share on other sites More sharing options...
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