PICO:
| P | I | C | O | |||
| LEVEL | Population | People | Intervention | Exposure | Comparison | Outcomes |
| EXAMPLE | Homeless | veterans | engagement | non-veterans | abstinence | |
| CONCEPT | Healthcare Professionals | Advance Practice Providers | Hiring | Physicians and Residents | health outputs and costs | |
| Keywords | ||||||
| 1 | Healthcare | |||||
| 2 | Advance Practice Providers | |||||
| 3 | Physician Assistants | |||||
| 4 | Nurse Practitioners | |||||
| 5 | Effectiveness | |||||
| 6 | Compare | |||||
| wildcards?/# | ||||||
| 1 | 305 | |||||
| 2 | 7 | |||||
| abbreviations | ||||||
| 1 | APP | |||||
| 2 | NP, PA | |||||
| truncation* | ||||||
| proximity-adj3 | ||||||
| MeSH musts | Primary Care | |||||
| Physician assistant | ||||||
| Nurse Practitioners | ||||||
| Outcome Assessment (Health Care) | ||||||
| Size Search/# | Search Builder | |||||
| 0 | Search ((("Outcome Assessment (Health Care)"[Mesh] AND ( "Outcome Assessment (Health Care)/standards"[Mesh] OR "Outcome Assessment (Health Care)/statistics and numerical data"[Mesh] OR "Outcome Assessment (Health Care)/trends"[Mesh] ))) AND Advanced practice providers) AND primary care Schema: all | |||||
| 0 | Search ((("Outcome Assessment (Health Care)"[Mesh] AND ( "Outcome Assessment (Health Care)/standards"[Mesh] OR "Outcome Assessment (Health Care)/statistics and numerical data"[Mesh] OR "Outcome Assessment (Health Care)/trends"[Mesh] ))) AND Advanced practice providers) AND primary care | |||||
| 7977 | Search "Outcome Assessment (Health Care)"[Mesh] AND ( "Outcome Assessment (Health Care)/standards"[Mesh] OR "Outcome Assessment (Health Care)/statistics and numerical data"[Mesh] OR "Outcome Assessment (Health Care)/trends"[Mesh] ) | |||||
| 12 | Search primary care effectiveness of advance practice providers | |||||
| 7 | Search ((Advanced Practice Providers) AND Primary care) AND comparative effectiveness | |||||
| 305 | Search Health outcomes for Advanced practice providers | |||||
| 115 | Search Effectiveness of Advanced Practice Providers | |||||
SCOPE of Review:
| # | Author(s), Title, Journal | Pick 1 | Population | Theory | Setting | Measures | (personal notes) | (articles cited I need to get) | 1-4 |
| 1 | Lori Freedman, Molly Frances Battistelli, Caitlin Gerdts, Monica McLemored, Radical or rountine? Nurse practitioners, nurse-midwives, and physician assistants as abortion providers, Reproductive Health matters | OP/commentary | Patients receiving abortions | Abortion provision is a vital primary care procedure | CA - Health clinics | Procedure complications | No difference in # of complications, APP=MD in providing abortions | Health Workforce Pilot Project #171 | 2 |
| 2 | Kreeftenberg, HG, Pouwels, S, Bindels, AJGH, de Bie, A, van der Voort, PHJ, Impact of the Advanced Practice Provider in Adult Critical Care: A Systematic Review and Meta-Analysis, Crit Care Med | Review | Advanced Practice Providers (APP) and residents +fellows | n/a | Meta-analysis | Length of stay, mortality | No significant difference, APP = residents | 1 | |
| 3 | Lovink, MH, Persoon, A, Koopmans, RTCM, Van Vught, AJAH, Schoonhoven, L, Laurant, MGH, Effects of substituting nurse practitioners, physicians assistant or nurses for physicians concerning healthcare for the ageing population: a systematic literature review, Journal of Advanced Nursing | Review | Physicians, APPs | n/a | Meta-analysis | Patient outcomes, resource use, and cost | APPs can achieve as good outcomes as MDs | 1 | |
| 4 | Faza, N; Akeroyd, J; Ramsey, D; Shah, T; Nasir, K; Deswal, A; Ballantyne, C; Petersen, L; Virani, S, Effectiveness of NPs and Pas in managing diabetes and cardiovascular disease, Journal of American Academy of Physician Assistants | Report | APPs in VA facilities | n/a | 130 VA facilities | resource use and health outcomes for treatments of CVD and DM | Both NP and PA equally effective in treating CVD and DM | 2 | |
| 5 | Marleen Hermien Lovink1, Anke Persoon2, Anneke JAH van Vught3, Lisette Schoonhoven1,4, Raymond TCM Koopmans1,5, Miranda GH Laurant, Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study, BMJ Open | Report | elderly | n/a | nursing homes in Netherlands | Meta-analysis with realism | Study so far inconclusive | 4 | |
| 6 | Ying Xue,1 James S. Goodwin,2 Deepak Adhikari,2 Mukaila A. Raji,2 and Yong-Fang Kuo2, Trends in Primary Care Provision to Medicare Beneficiaries by Physicians, Nurse Practitioners, or Physician Assistants: 2008-2014, Journal Primary Care Community Health | Report | elderly | n/a | US medicare | Medicare service utilization summary | Increase in APPs, more interesting to know which states in particular | 3 | |
| 7 | Emily A. Gadbois,1 Edward Alan Miller,1 Denise Tyler,2,3 and Orna Intrator4,5, Trends in State Regulation of Nurse Practitioners and Physician Assistants 2001-2010, Medical Care Research and Review | Review | PA and NP | n/a | US | State legislative changes | Move towards less restriction on practice, but more entry to practice requirements | 3 | |
| 8 | Dill MJ1, Pankow S, Erikson C, Shipman S., Survey shows consumers open to a greater role for physician assistants and nurse practitioners, Health Affairs (millwood) | Article | Preselected population meant to be rep US pop | n/a | US | AAMC survey | Consumers open to APP as care is care | AAMC Consumer survey | 1 |
| 9 | Coldiron B1, Ratnarathorn M2., Scope of Physician Procedures Independently billed by mid-level providers in the office setting, JAMA Dermatology | Report | elderly | n/a | US medicare | Medicare service utilization summary | Specialists feel threatened by encrouching APPs into speciality services | CMS procedural summary | 1 |
| 10 | Are Advanced Providers Prepared to Care for the Agricultural Population?, Mary Cramer, PhD, RN, Kathy Wulf, DNP, FNP-C, Mary Wendl, MS, RN, and Heidi Keeler, PhD, RN, Journal for Nurse Practitioners | Report | rural APPs | n/a | Nebraska | Survey questions regarding rural respiratory diseases | APPs are projected to cover primary care, but rural areas might take more time | 1 | |
| 11 | DeWolfe C1, Birch S2, Callen Washofsky A3, Gardner C4, McCarter R5, Shah NH4., Patient Outcomes in a Pediatric Hospital Medicine Service Staffed With Physicians and Advanced Practice Providers, Hospital Pediatrics | Report | Hospital patients | n/a | US hospitals | Analysis of hospital patients with specific diagonistic codes: asthma, bronchitis, cellulitis, and pneumonia | APPs performed just as well as residents | 1 |
SCOPE of Review 2:
| SCOPE | TYPE | RELEVANCE | OTHER | SNOWBALL | REL LEVEL | ||||
| # | Author(s), Title, Journal | Pick 1 | Population | Theory | Setting | Measures | (personal notes) | (articles cited I need to get) | 1-4 |
| 1 | Lori Freedman, Molly Frances Battistelli, Caitlin Gerdts, Monica McLemored, Radical or rountine? Nurse practitioners, nurse-midwives, and physician assistants as abortion providers, Reproductive Health matters | Literature Review | 4 | 3 | 4 | 4 | No difference in # of complications, APP=MD in providing abortions | Health Workforce Pilot Project #171 | 3.75 |
| 2 | Kreeftenberg, HG, Pouwels, S, Bindels, AJGH, de Bie, A, van der Voort, PHJ, Impact of the Advanced Practice Provider in Adult Critical Care: A Systematic Review and Meta-Analysis, Crit Care Med | Systematic Review | 3 | 1 | 4 | 4 | No significant difference, APP = residents | 3 | |
| 3 | Lovink, MH, Persoon, A, Koopmans, RTCM, Van Vught, AJAH, Schoonhoven, L, Laurant, MGH, Effects of substituting nurse practitioners, physicians assistant or nurses for physicians concerning healthcare for the ageing population: a systematic literature review, Journal of Advanced Nursing | Systematic Review | 3 | 2 | 3 | 4 | APPs can achieve as good outcomes as MDs | 3 | |
| 4 | Faza, N; Akeroyd, J; Ramsey, D; Shah, T; Nasir, K; Deswal, A; Ballantyne, C; Petersen, L; Virani, S, Effectiveness of NPs and Pas in managing diabetes and cardiovascular disease, Journal of American Academy of Physician Assistants | Systematic Review | 3 | 3 | 3 | 4 | Both NP and PA equally effective in treating CVD and DM | 3.25 | |
| 5 | Marleen Hermien Lovink1, Anke Persoon2, Anneke JAH van Vught3, Lisette Schoonhoven1,4, Raymond TCM Koopmans1,5, Miranda GH Laurant, Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study, BMJ Open | Systematic Review | 1 | 2 | 3 | 2 | Study so far inconclusive | 2 | |
| 6 | Ying Xue,1 James S. Goodwin,2 Deepak Adhikari,2 Mukaila A. Raji,2 and Yong-Fang Kuo2, Trends in Primary Care Provision to Medicare Beneficiaries by Physicians, Nurse Practitioners, or Physician Assistants: 2008-2014, Journal Primary Care Community Health | Literature Review | 2 | 3 | 3 | 4 | Increase in APPs, more interesting to know which states in particular | 3 | |
| 7 | Emily A. Gadbois,1 Edward Alan Miller,1 Denise Tyler,2,3 and Orna Intrator4,5, Trends in State Regulation of Nurse Practitioners and Physician Assistants 2001-2010, Medical Care Research and Review | Literature Review | 2 | 2 | 4 | 4 | Move towards less restriction on practice, but more entry to practice requirements | 3 | |
| 8 | Dill MJ1, Pankow S, Erikson C, Shipman S., Survey shows consumers open to a greater role for physician assistants and nurse practitioners, Health Affairs (millwood) | Literature Review | 3 | 2 | 4 | 3 | Consumers open to APP as care is care | AAMC Consumer survey | 3 |
| 9 | Coldiron B1, Ratnarathorn M2., Scope of Physician Procedures Independently billed by mid-level providers in the office setting, JAMA Dermatology | Systematic Review | 3 | 3 | 4 | 4 | Specialists feel threatened by encrouching APPs into speciality services | CMS procedural summary | 3.5 |
| 10 | Are Advanced Providers Prepared to Care for the Agricultural Population?, Mary Cramer, PhD, RN, Kathy Wulf, DNP, FNP-C, Mary Wendl, MS, RN, and Heidi Keeler, PhD, RN, Journal for Nurse Practitioners | Literature Review | 4 | 3 | 3 | 2 | APPs are projected to cover primary care, but rural areas might take more time | 3 | |
| 11 | DeWolfe C1, Birch S2, Callen Washofsky A3, Gardner C4, McCarter R5, Shah NH4., Patient Outcomes in a Pediatric Hospital Medicine Service Staffed With Physicians and Advanced Practice Providers, Hospital Pediatrics | Systematic Review | 4 | 3 | 4 | 4 | APPs performed just as well as residents | 3.75 | |
GREY (Non-empirical Matrix):
| REFERENCE & PURPOSE | SUBJECTS | METHODS | VARIABLES | FINDINGS | COMMENTS | |||||||||
| Author(s), Title, Journal | Type | Year | Purpose/Questions | Theoretical Framework | # | Sample Demo | Characteristics | DESIGN | TOOLS | Year Data Collected | Control | Intervention | (K.I.S.S.) | (hmmm….) |
| Brooks, PB & Fulton, ME, Demonstrating advanced practice provider value: Implementing a new advanced practice provider billing algorithm, JAANP | Report | 2019 | Advanced practice providers utilization in healthcare | n/a | 1 | Medical University of South Carolona Health clinic | Single medical clinic belonging to medical university | Evaluation | Electronic Health Record | 2017-2017 | n/a | n/a | Advanced Practice Providers work indicates better utilization and better productivity | Standardizing billing practices might yield different results statewide. |
| Kreeftenberg, HG, Pouwels, S, Bindels, AJGH, de Bie, A, van der Voort, PHJ, Impact of the Advanced Practice Provider in Adult Critical Care: A Systematic Review and Meta-Analysis, Crit Care Med | Review | 2019 | Evaluate advanced practice providers in critical care | n/a | 30 | Comparative cohort studies between APP and residents/fellows | Comparing length of stay and mortality from other studies | Meta-analysis | Newcastle-Ottawa scale, Cohen's kappa, | 2019 | n/a | n/a | No difference between acute care given by advanced practice providers and physician resident/fellows | A further look into the geographic areas of the studies involved would be interesting. |
| Lovink, MH, Persoon, A, Koopmans, RTCM, Van Vught, AJAH, Schoonhoven, L, Laurant, MGH, Effects of substituting nurse practitioners, physicians assistant or nurses for physicians concerning healthcare for the ageing population: a systematic literature review, Journal of Advanced Nursing | Review | 2017 | Evaluate substitution physicians with NP, PA, RN in long-term care facilities | n/a | 10 | 2 Randomized studies and 8 comparative studies | Comparing Patient outcomes, care provider outcomes, process of care outcomes, resource use, costs of 10 other literatures | Meta-analysis | PubMed, EMBASE, CINAHL, PyscINFO, CENTRAL, Web of Science | 1995-2015 | n/a | n/a | Possible for NP, PA, and RNs to achieve just as good outcomes as physicians. | Resource use and costs are not compared b/c "too limited to draw conclusions." What is the exact stumbling block? |
| Huff, C, Shrinking the Psychiatrist Shortage, Managed Care | Editorial (journal) | 2018 | Growing role of NP and PA in psychiatry to make up for shortages | n/a | 37889 | Number of Psychiatrists in US | Decline by 0.2% from 2003 to 2013 | Article | JAMA Psychiatry, Health Affairs, NCBH, Annals of Emergency Medicine | 2013-2015 | n/a | n/a | Shortage of Psychiatrists are being answered by Advanced practice providers | Health Outcomes between APP and psychiatrist would be a nice comparison |
| Faza, N; Akeroyd, J; Ramsey, D; Shah, T; Nasir, K; Deswal, A; Ballantyne, C; Petersen, L; Virani, S, Effectiveness of NPs and Pas in managing diabetes and cardiovascular disease, Journal of American Academy of Physician Assistants | Report | 2019 | Effectiveness of NP and PA in treating CVD and DM | n/a | 130 | Veteran Affairs facilities | Population consistenting solely of veterans, CVD 185,694 and DM 156,034 | Regression Analysis | Electronic Health Records | 2018 | n/a | n/a | Both PA and NP are equally effective in care and resource use | Can VA treatments be extended to the general population? |
| Marleen Hermien Lovink1, Anke Persoon2, Anneke JAH van Vught3, Lisette Schoonhoven1,4, Raymond TCM Koopmans1,5, Miranda GH Laurant, Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study, BMJ Open | Report | 2019 | How do advanced practice providers contribute to healthcare? | n/a | 10+ | Dutch Nursing homes | Dutch national nursing homes | Case studies, realists evaluation principles | SPSS, cross-case analysis | 2017- | n/a | n/a | Case studies are currently inconclusive | European systems might work differently from US systems |
| Ying Xue,1 James S. Goodwin,2 Deepak Adhikari,2 Mukaila A. Raji,2 and Yong-Fang Kuo2, Trends in Primary Care Provision to Medicare Beneficiaries by Physicians, Nurse Practitioners, or Physician Assistants: 2008-2014, Journal Primary Care Community Health | Report | 2019 | Document trends in alternative primary care models | n/a | 775,556 | US medicare | Elderly population 65+ | Serial Cross-sectional analysis | Medicare Beneficiary Summary file, Medicare Carrier file, Outpatient Standard Analytic file | 2008-2014 | n/a | n/a | Increase in shared practices + increase in advanced practice providers | Which specific states were responsible for the biggests increase in share practice. |
| Emily A. Gadbois,1 Edward Alan Miller,1 Denise Tyler,2,3 and Orna Intrator4,5, Trends in State Regulation of Nurse Practitioners and Physician Assistants 2001-2010, Medical Care Research and Review | Review | 2019 | Examine PA and NP regulation over time to determine future trends | n/a | 50 | All 50 states information on PA and NP regulations | National US | Evaluation | Perason, State Regulation of Physician Assistant Practice Reports | 2001-2010 | n/a | n/a | Move towards less restrictive regulations and higher entry-to-practice requirements for NP and PA | How much of a factor was cost? |
| Green LV, Savin S, Lu Y, Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication, Healf Affairs (millwood) | Editorial (journal) | 2013 | Shortages of doctors can be answered via nonphysicians | n/a | 20 | Average # of expected appt a day | US physician stat averages | Theoretical Estimate | Affordable Care Act | 2003-2010 | n/a | n/a | Trends towards cost efficiency and group practice should be enough to offset physician shortage. | Which states in particular are expected to face shortages and how is the distribution of healthcare professionals possible? |
| Dill MJ1, Pankow S, Erikson C, Shipman S., Survey shows consumers open to a greater role for physician assistants and nurse practitioners, Health Affairs (millwood) | Editorial (journal) | 2013 | How willing are patients to accept healthcare from PA and NP? | n/a | 2053 | Population weighted based on sex, age, race, and ethnicity, employment, and income for better US rep | External firm conducts survey with their preselected panelists of more than 670,000 people | Survey | Association of American Medical Colleges Consumer Survery | 2013 | n/a | n/a | Patients are open to the idea of receiving care from PA and NP | Scope of practice depending on state regulation appears to be the biggest hurdle in for APPs |
| Coldiron B1, Ratnarathorn M2., Scope of Physician Procedures Independently billed by mid-level providers in the office setting, JAMA Dermatology | Report | 2019 | What is the scope of independent billing for medicare by APPs? | n/a | 4,000,000 | Procedure for dermatology | Dermatology claims under Medicare Part B | Evaluation | SAS, Medicare | 2012 | n/a | n/a | Advanced Practice Providers have expanded into independent practice at the expense of patient safety + quality of care, limits should be placed so they remain in E/M services | Points to training levels, but not the health outcomes |
| Lori Freedman,a Molly Frances Battistelli,b Caitlin Gerdts,c Monica McLemored, Radical or rountine? Nurse practitioners, nurse-midwives, and physician assistants as abortion providers, Reproductive Health matters | Opinion/Commentary | 2019 | The new abortions provided by advanced practice providers are a old tradition | Left, Pro-abortion | 16998 | Patients who received abortions | 53% abortions done by APP 47% done by physicians | Study | EHR, excel | 2014-2016 | physician treatment | APP treatment | APPs are equally as good as physicians in providing abortions, not a new concept | Should abortions also be extended to 2 yr technicians? |
| Amira
del Pino-Jones, MD, Brian Wolfe, MD, Kinsey Wimmer, MS, PA-C, Kasey Bowden,
MSN, FNP, Laura Rosenthal, DNP, ACNP, Carmella Nogar, MS, PA-C, Kristin
Furfari, MD, and Ethan Cumbler, MD, Physician Perceptions of Advanced Practice Providers on Hospitalist Teams, Journal for Nurse Practitioners |
Report | 2019 | What are MD perceptions of APPs? | Pro-Allied Health | 25 | Hospitalists at academic institutions | Hospitalists that use and respond to email | Survey | Likert Scale | 2018-2019 | n/a | n/a | Hospitalist feel that NP and PA increase efficiceny and job satisfaction | Sample size too small. |
| Are Advanced Providers Prepared to Care for the Agricultural Population?, Mary Cramer, PhD, RN, Kathy Wulf, DNP, FNP-C, Mary Wendl, MS, RN, and Heidi Keeler, PhD, RN, Journal for Nurse Practitioners | Report | 2019 | How prepared are APPs to deal with rural health conditions? | n/a | 56 | Nebraska NPs and Pas | APPs in Nebraska family practices | Survey | Dillman-tailored design, SPSS | 2018-2019 | n/a | n/a | A significant portion of APPs are unprepared for rural respiratory conditions | Sample size too small. |
| DeWolfe C1, Birch S2, Callen Washofsky A3, Gardner C4, McCarter R5, Shah NH4., Patient Outcomes in a Pediatric Hospital Medicine Service Staffed With Physicians and Advanced Practice Providers, Hospital Pediatrics | Report | 2019 | Compare the health outcomes for patients treated by MD+residents to MD+APPs | n/a | Hospital Patients | Patients with asthma, bronchitis, cellulitis, and pneumonia | Evaluation | Comparative length of stay, readmission, ICU transfer, and hospital charges | 2007-2011 | Hospitalist and Resident Service [HRS] | Hospitalist and Advanced Practice Providers [HAPPS] | HAPPS performed equally as well as HRS | Hospital charges is not the same as health outcomes, but is qually important | |
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