There has been ongoing scrutiny of the physician assistant profession since the earliest days when federal grant money for the study of workforce was virtually growing on trees. Studies in more recent times tend to be more narrowly focused on specific aspects of practice than earlier efforts.
Quality of Care
Cost Effectiveness
Patient Satisfaction
Proficiency
Quality of Care
Quality of care delivered by physician assistants has been studied since the earliest days of the profession with consistently favorable findings. Notable articles include the 1979 evaluation of studies by Harold C. Sox MD in the Annals of Internal Medicine. His analysis of 21 studies concluded that NPs and PAs “provide office-based care that is indistinguishable from physician care.” Sox HC Jr. Quality of patient care by nurse practitioners and physician's assistants: a ten-year perspective. Ann Intern Med. 1979 Sep;91(3):459-68.
In 1986, the US Congress, Office of Technology Assessment, published the seminal report, “ Nurse Practitioners, Physicians Assistants, and Certified Nurse-Midwives. A Policy Analysis, which found that, “Within the limits of their expertise, PAs provide care that is equivalent in quality to the care provided by physicians.” (Case Study 37) OTA-HCS-37, Washington DC: US Gov Printing Office, 1986.
Smaller, more specific studies through the years document significant improvements in quality in various settings and patient populations.
Unable to sustain a residency program, Hurley Medical Center in Flint, Michigan, established a trauma program in which PAs fill the roles normally filled by surgical residents. Despite an increase in patient acuity, the program resulted in an overall decrease in transfer time to OR of 43 percent, to the trauma ICU of 51 percent, and to the surgical floor of 20 percent. Length of stay for neurotrauma ICU patients decreased by 33 percent. Miller W, Riehl E, Napier M, Barber K, Dabideen, H. Use of Physician Assistants as Surgery/Trauma House Staff at an American College of Surgeons-Verified Level II Trauma Center. Journal of Trauma. Volume 44(2) February 1998 pp 372-376.
A study of trauma teams at St. Anthony Central Hospital in Denver, “found that the addition of PAs significantly reduced overall mortality as well as mean and median LOS in the hospital. The addition of PAs to the trauma panel reduced overall mortality by 25.5%. The significant percent reduction in mean and median hospital LOS with addition of PAs to the trauma service was 7.9% and 3.6%, respectively.” Mains C, Scarborough K, Bar-Or R, Hawkes A, Huber J, Bourg P, David Bar-Or D. Staff Commitment to Trauma Care Improves Mortality and Length of Stay at a Level I Trauma Center. J Trauma. 2009 May;66(5):1315-20.
A 2005 study of the quality of care provided by physician assistants and nurse practitioners who are primary care providers for patients with HIV found that “ the quality of HIV care provided by NPs and PAs was similar to that of physician HIV experts and generally better than physician non-HIV experts. Wilson IB et al. Quality of HIV Care Provided by Nurse Practitioners, Physician Assistants, and Physicians. Annals of Internal Medicine. November 15, 2005;143(10):729-736.
A study in the American Journal of Perinatology examined the shift from residents to physician assistants and nurse practitioners in staffing a 26-bed neonatal intensive care unit in a New York hospital. Nonphysician staffing was found to be expensive in comparison to staffing by residents, but access to NICU services and quality of care were preserved and enhanced when nonphysician providers staffed the unit. Schulman M, Lucchese KR, Sullivan AC. Transition from housestaff to nonphysicians as neonatal intensive care providers: cost, impact on revenue, and quality of care. Am J Perinatol. 1995 Nov;12(6):442-6.
Research on physician assistant utilization in long-term care confirms the benefits associated with PA utilization. One early study revealed that when a PA was added to a long-term care facility’s medical team, the amount and quality of care residents received increased. Sorem, Kevin R., PA-C, and Portnoy, Valery A., M.D. “Decreased Rates of Polypharmacy, Hospitalization and Mortality through Geriatric Medical Team Involvement in a Nursing Home.” George Washington University, May 1983
Subsequent studies have shown that the introduction of a PA to a nursing home medical team both increases the medical attention (measured by visits and medical orders) that patients receive and decreases patient hospitalization days by as much as 68 percent.Caprio found several areas of potential benefit from the inclusion of midlevel providers in the nursing home setting, including improved quality of care, improvement in several disease-specific quality indicators, and increased satisfaction on the part of physicians, residents, and patients’ families. Caprio T. "Physician Practice in the Nursing Home: Collaboration wtih Nurse Practitioners and Physician Assistants." Annals of Long-Term Care, Volume 14, Number 3; March 2006.
