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

NCT ID: NCT01835444

Last Updated: 2015-05-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

2382 participants

Study Classification

OBSERVATIONAL

Study Start Date

2013-04-30

Study Completion Date

2015-05-31

Brief Summary

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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?

Detailed Description

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Conditions

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Substitution of Care

Study Design

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Study Time Perspective

PROSPECTIVE

Study Groups

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MD model

Hospital wards at which ward care is provided only by Medical Doctors (MDs)

No interventions assigned to this group

PA/MD model

Hospital wards at which ward care is provided by both Physician Assistants (PAs) and Medical Doctors (MDs)

PA/MD model

Intervention Type OTHER

Intervention wards are hospital wards at which ward care is provided by both Physician Assistants (PAs) and Medical Doctors (MDs)

Interventions

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PA/MD model

Intervention wards are hospital wards at which ward care is provided by both Physician Assistants (PAs) and Medical Doctors (MDs)

Intervention Type OTHER

Eligibility Criteria

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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

* 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


* Terminal patients
* Not fluent in Dutch language
* Age \< 18 years
* Patients in daycare
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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ZonMw: The Netherlands Organisation for Health Research and Development

OTHER

Sponsor Role collaborator

Radboud University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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M.G.H. Laurant, PhD

Role: PRINCIPAL_INVESTIGATOR

IQ healthcare, UMC St Radboud

Locations

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Scheper Ziekenhuis

Emmen, Drenthe, Netherlands

Site Status

Gelre Ziekenhuizen

Apeldoorn, Gelderland, Netherlands

Site Status

Rijnstate

Arnhem, Gelderland, Netherlands

Site Status

Slingeland Ziekenhuis

Doetinchem, Gelderland, Netherlands

Site Status

Ziekenhuis de Gelderse Vallei

Ede, Gelderland, Netherlands

Site Status

Radboud University Nijmegen Medical Centre

Nijmegen, Gelderland, Netherlands

Site Status

Canisius Wilhelmina ziekenhuis

Nijmegen, Gelderland, Netherlands

Site Status

Streekziekenhuis Koningin Beatrix

Winterswijk, Gelderland, Netherlands

Site Status

Laurentius Ziekenhuis

Roermond, Limburg, Netherlands

Site Status

Laurentius Ziekenhuis

Roermond, Limburg, Netherlands

Site Status

Orbis Medisch Centrum

Sittard, Limburg, Netherlands

Site Status

VieCuri Medical Center

Venlo, Limburg, Netherlands

Site Status

Jeroen Bosch Ziekenhuis

's-Hertogenbosch, North Brabant, Netherlands

Site Status

Lievensberg Ziekenhuis

Bergen op Zoom, North Brabant, Netherlands

Site Status

Elkerliek ziekenhuis

Helmond, North Brabant, Netherlands

Site Status

Fransiscus Ziekenhuis

Roosendaal, North Brabant, Netherlands

Site Status

St. Elisabeth Ziekenhuis

Tilburg, North Brabant, Netherlands

Site Status

TweeSteden Ziekenhuis

Tilburg, North Brabant, Netherlands

Site Status

Tjongerschans ziekenhuis

Heerenveen, Provincie Friesland, Netherlands

Site Status

Reinier de Graaf Gasthuis

Delft, South Holland, Netherlands

Site Status

HagaZiekenhuis

The Hague, South Holland, Netherlands

Site Status

Medisch Centrum Haaglanden

The Hague, South Holland, Netherlands

Site Status

UMC Utrecht

Utrecht, Utrecht, Netherlands

Site Status

Van Weel Bethesda Ziekenhuis

Dirksland, Zeeland, Netherlands

Site Status

Countries

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Netherlands

References

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Timmermans MJC, van Vught AJAH, Peters YAS, Meermans G, Peute JGM, Postma CT, Smit PC, Verdaasdonk E, de Vries Reilingh TS, Wensing M, Laurant MGH. The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study. PLoS One. 2017 Aug 9;12(8):e0178212. doi: 10.1371/journal.pone.0178212. eCollection 2017.

Reference Type DERIVED
PMID: 28793317 (View on PubMed)

Timmermans MJC, van den Brink GT, van Vught AJAH, Adang E, van Berlo CLH, Boxtel KV, Braunius WW, Janssen L, Venema A, van den Wildenberg FJ, Wensing M, Laurant MGH. The involvement of physician assistants in inpatient care in hospitals in the Netherlands: a cost-effectiveness analysis. BMJ Open. 2017 Jul 10;7(7):e016405. doi: 10.1136/bmjopen-2017-016405.

Reference Type DERIVED
PMID: 28698344 (View on PubMed)

Timmermans MJ, van Vught AJ, Van den Berg M, Ponfoort ED, Riemens F, van Unen J, Wobbes T, Wensing M, Laurant MG. Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands. J Eval Clin Pract. 2016 Jun;22(3):395-402. doi: 10.1111/jep.12499. Epub 2015 Dec 23.

Reference Type DERIVED
PMID: 26695837 (View on PubMed)

Timmermans MJ, van Vught AJ, Wensing M, Laurant MG. The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol. BMC Health Serv Res. 2014 Jan 28;14:43. doi: 10.1186/1472-6963-14-43.

Reference Type DERIVED
PMID: 24472112 (View on PubMed)

Other Identifiers

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80-82310-97-12094

Identifier Type: -

Identifier Source: org_study_id

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