Advance practice nurse outcomes 1990–2008: A systematic review

University of Maryland School of Nursing, Baltimore, MD, USA.
Nursing economic$ (Impact Factor: 0.8). 09/2011; 29(5):230-50; quiz 251.
Source: PubMed


Advanced practice registered nurses have assumed an increasing role as providers in the health care system, particularly for underserved populations. The aim of this systematic review was to answer the following question: Compared to other providers (physicians or teams without APRNs) are APRN patient outcomes of care similar? This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included. Use of clinical nurse specialists in acute care settings can reduce length of stay and cost of care for hospitalized patients. These results extend what is known about APRN outcomes from previous reviews by assessing all types of APRNs over a span of 18 years, using a systematic process with intentionally broad inclusion of outcomes, patient populations, and settings. The results indicate APRNs provide effective and high-quality patient care, have an important role in improving the quality of patient care in the United States, and could help to address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care.

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Available from: Robin Newhouse, Dec 30, 2013
    • "Leadership, professional autonomy, and working in multidisciplinary teams are key to effective performance of the APN role (Dowling et al., 2013). Newhouse et al. (2011) concluded that a collaborative approach between APNs with physicians and other providers leads to higher quality of care and better health care systems. "
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    ABSTRACT: Objectives: To identify, assess and summarize available scientific evidence about the effect of interventions deployed by advanced practice nurses when providing care to older people in different care settings, and to describe the roles and components of the interventions developed by these professionals. Background: In older people, evidence of advanced practice roles remains dispersed along different contexts, approaches and settings; there is little synthesis of evidence, and it is not easy to visualize the different practice models, their components, and their impact. Design: Systematic review. Data sources: Sixteen electronic databases were consulted (1990-2014). The research also included screening of original studies in reviews and reports from Centers of Health Services Research and Health Technology Agencies. Review methods: Studies were assessed by two reviewers with the Cochrane risk of bias tool. They were classified depending on the type of follow-up (long and short-term care) and the scope of the service (advanced practice nurses interventions focused on multimorbid patients, or focused on a specific disease). Results: Fifteen studies were included. In long-term settings, integrative, multi-component and continuous advanced practice nursing care, reduced readmissions, and increased patients' and caregivers' satisfaction. Advanced practice nurses were integrated within multidisciplinary teams and the main interventions deployed were patient education, multidimensional assessments and coordination of multiple providers. Conclusion: Positive results have been found in older people in long-term care settings, although it is difficult to discern the specific effect attributable to them because they are inserted in multidisciplinary teams. Further investigations are needed to evaluate the cost-effectiveness of the two modalities detected and to compare internationally the interventions developed by advanced practice nurses.
    International journal of nursing studies 10/2015; DOI:10.1016/j.ijnurstu.2015.10.010 · 2.90 Impact Factor
    • "The review included studies on the impact of masters-prepared specialist nursing roles focused on care coordination to address the needs of specific patient groups, such as patients with diabetes or multiple sclerosis. Results from a further systematic review that included studies on the impact of gerontological nurse practitioners, also suggest that such roles can help reduce length of stay (Newhouse et al. 2011). A number of primary studies indicate a clear contribution by specialist nurses to interdisciplinary interventions shown to be effective in reducing length of stay. "
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    ABSTRACT: To identify the potential benefits of dementia specialist nursing and to inform the implementation of roles to support people with dementia during hospital admission. Extended stays and adverse events mean that hospital admissions are costly for people with dementia, and patient experiences and outcomes can be poor. Specialist nurses have been identified as having potential to enhance care quality, reduce excess stays and reduce costs, but the evidence base for dementia specialist nurse roles has not previously been synthesised. Scoping review. Cochrane Library, Campbell Collaboration, Clinical Evidence, Evidence-Based Medicine, York Centre for Reviews and Dissemination, PubMed, Medline, CINAHL and PsycInfo databases and internet searches and personal libraries/expert consultation to identify grey literature. Initial scoping searches were used to inform more focused systematic searches. Studies directly evaluating dementia nurse specialist roles or giving evidence of effectiveness of interventions/services that could be delivered by them to improve core outcomes were identified by one reviewer and verified by a second reviewer. While direct evidence for the effectiveness of these roles is lacking, a number of areas were identified in which a nurse specialist role could make a contribution, including preventing adverse events and improving patient experiences and outcomes. There is a considerable body of evidence for the effectiveness of these interventions although the volume of evidence for specific interventions is not always significant. The evidence indicates that a skilled dementia specialist nurse, undertaking a clearly defined role, and working directly with people with dementia and their carers for a significant proportion of the time, could benefit people with dementia in hospitals and their family carers. Clear guidance for the development and implementation of dementia specialist nurse roles in acute hospital settings. © 2014 John Wiley & Sons Ltd.
    Journal of Clinical Nursing 12/2014; 24(9-10). DOI:10.1111/jocn.12717 · 1.26 Impact Factor
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    • "NPs improved resource utilization and access to care [14, 18–20], increased primary care services in the community [7], and reduced costs [15]. Over the past 30 years, a number of literature reviews and systematic reviews have summarized the findings of studies evaluating NPs [21–25]. The reviews have consistently shown no difference in the health outcomes of patients receiving NP care when compared to patients receiving physician care, but often both quality of care and patient satisfaction are higher with NP care. "
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    ABSTRACT: Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (), NP-transition (), NP-inpatient (), CNS-outpatient (), CNS-transition (), and CNS-inpatient (). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.
    09/2014; DOI:10.1155/2014/896587
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