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APRNs Improve quality outcomes, cost of care


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By Jennifer Thew, RN

Healthcare executives don’t need a crystal ball to predict the current interest in achieving safe, high-quality, cost-effective care that will continue to grow well into the future.

Some organizations, like Englewood, Colorado–based Catholic Health Initiatives, a nonprofit health system with operating revenues of $15.2 billion in fiscal year 2015, have already recognized that a bright future will require them to alter care delivery models to meet the demands of the nation’s changing healthcare system.

"We were beginning to look at what was going to be happening in the future and where we were going and all the different things that we needed to do to increase quality and decrease costs at the same time," says Kathleen D. Sanford, DBA, RN, FACHE, FAAN, senior vice president and chief nursing officer at CHI. "We were also looking at the types of shortages we were going to have in the future, and we figured out that there is no way that we are going to be able to continue doing things the way that we are doing things right now."

To help plot a new path, leaders at CHI compared evidence on quality outcomes of advanced practice practitioners (advanced practice RNs [APRN]—also referred to as APNs—and physician assistants) to quality outcomes of physicians.

A large body of evidence has found that APPs produce quality outcomes similar to or better than physicians. For example, a systemic review of 71 studies published from 1990 to 2009 found that clinical nurse specialists, certified nurse midwives, and nurse practitioners produced quality, financial, and clinical outcomes that were equal to or better than physicians.

At the time it was done, there were not enough studies on certified registered nurse anesthetists that met the criteria to be included in the review. However, newer studies have found that CRNAs and physicians have similar complication and mortality rates, and care by a CRNA did not increase risk of harm to patients.

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