Substitution of Care Clinical Trial
Official title:
Worthy Assistants: Does Substituting Hospital Ward Care From Medical Residents to Physician Assistants Result in Cost Savings?
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?
n/a
Time Perspective: Prospective