The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations.
Allison A Norful, Krystyna de Jacq, Jianfang Liu and 3 others
PMID 33534285WHAT IT FOUND
Increasing nurse practitioner and physician assistant supply per county was associated with fewer emergency visits and hospitalizations for Medicaid patients with chronic conditions.
Physician supply alone showed no such benefit. One respiratory finding was opposite.
Key findings
01Higher nurse practitioner supply was associated with reduced emergency visits for diabetes, cardiovascular disease, and mental illness, but increased respiratory visits.
02Physician supply alone had no significant impact on emergency visits or hospitalizations for any chronic condition.
03Increased physician assistant supply was associated with reduced hospitalizations for cardiovascular disease and mental illness.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used aggregate county-level data and could not link specific patients to specific providers. It could not determine how many nurse practitioners worked independently versus under physician oversight. The design is observational, so it shows association but cannot prove that increasing workforce supply causes better outcomes. Confounding factors like local healthcare infrastructure or patient behavior may influence results. The finding of increased respiratory emergency visits with higher NP supply was unexpected and unexplained.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not interpret this as evidence that hiring more nurse practitioners directly causes fewer emergency visits. The study shows an association at the county level and cannot prove causation or identify which specific care practices led to the outcomes.