Nurse Practitioners and Healthcare

¶ … Quality of Care Provided by Nurse Practitioners

Cost and quality of healthcare access are two inter-related concepts that are central to the healthcare debate in the United States of America. The study will compare the effectiveness of quality and costs between NP and physicians. To achieve this purpose, the study will be guided y the following research questions; how does the cost of care provided by nurse practitioners compare to that of physicians: and how is the quality of care provided by nurse practitioners? The Jean Watson's Theory of Human Caring is adopted for this study. The study will be conducted in five different hospitals that have health services being provided by both NP and physicians. Study participants will be selected from hospital databases with the help of hospital staff to establish which patients will be more suited for the study. Research questionnaires will be used for data collections. The data collected will be analyzed through statistical program (SPSS, 2015 version) and descriptive analysis.

Purpose of Study

Cost and quality of healthcare access are two inter-related concepts that are central to the healthcare debate in the United States of America (Stanik-Hutt et al., 2013). To contribute to this debate, this study narrows down to the costs and quality of care delivered by nursing practitioners (NP). In particular, the study will compare the effectiveness of quality and costs between NP and physicians. To achieve this purpose, the study will be guided y the following research questions.

Research Questions

Two research questions have been set towards realization of the study purpose;

i. How does the cost of care provided by nurse practitioners compare to that of physicians?

ii. How is the quality of care provided by nurse practitioners?

Literature Review

According to Fletcher, Copeland and Lowery (2011), nursing practitioners can provide primary care that is underutilized within the healthcare environment. By acquiring skills in patient care management and physical assessment, NP can become primary care providers delivering services such as diagnosing, ambulatory care settings and providing treatments for a variety of health problems. Based on this skill set, NPs are expected to provide services that are less costly. Fletcher et al. (2011) reveals that the number of Veterans who seek for the primary healthcare services from nursing practitioners since 1996 has increased by more than 200%, which is attributed to high quality and cost-effective services.

Litaker, Mion and Planavsky (2003), demonstrate that there are modest incremental costs for a complementary team approach for the management of chronic disease. The authors reveal that intervention of NPs and medical practitioners increases HDL-c prevalence by 7%, however, HbA1c for diabetes patients reduces from 7.9% to 7.0%. The microvascular complications were reduced by 25% and a reduction of 16% for non-fatal, fatal sudden death and myocardial infarction were recorded. Despite cost effectiveness carried out for NPs, the authors did not include personnel costs in their evaluation.

Allen et al. (2014) studied the cost-effectiveness of an intervention of nursing practitioners on patients suffering from CVD (cardiovascular disease). While the evidence-based practice to manage CVD is available, however, patient adherence to the therapies is slow. The authors argue that nursing practitioners can assist in providing the quality care at lower costs similar to the healthcare services delivered by other health care professionals. With the intervention of the nursing practitioners, the authors calculate the total costs per patients to manage the CVD. The outcome of the study reveals that the total costs per patient are $627. Moreover, the cost effectiveness shows that there is $157 reduction in cost for 1% drop in the systolic blood pressure. Moreover, $190 decline in cost for 1% drop in the diastolic blood pressure. Additionally, there is $149 decline in the cost of 1% per drop of HbA1c. A $40 decline in costs in 1% drop in LDL cholesterol is also recorded. The outcome of their research shows that management of CVD by NP is cost-effective for patients suffering from the high risk of CVD.

Kapu, Kleinpell & Pilon (2014) investigated the financial impact of NPs on inpatients at Vanderbilt University Hospital. The investigation was carried out based on the national initiatives targeting the cost effectiveness of NPs in the optimal healthcare environment because the health administrators believe that NPs can deliver cost savings as well as reducing costs of administration. The authors analyze the ROI (return on investment) after adding five teams of NPs. Software is used to evaluate the length of stay, and NPs quality metrics. The data collected was compared with the previous year's data. The finding of the research reveals that NPs demonstrated a huge decline in costs revealing that NPs used fewer resources in delivering a standardized quality of care.

Even though there's significant research on the quality and costs of healthcare provided by NP, research is still necessary based on the fact that, healthcare delivery is dynamic as healthcare services and technology used in healthcare changes continuously. With specificity to the U.S. healthcare system, this research is necessary to unearth the effects of healthcare policy changes in the country.

Theoretical framework

The Jean Watson's Theory of Human Caring is adopted for this study. The theory asserts that a human being cannot be healed as an object, but rather, as a part of an environment, nature, and the larger universe (Ozan, Okumus & Lash, 2015). This study deals with environmental issues; cost and quality of care, which are considered to influence healing through satisfaction perceived by a patient. The objective of the theory is to establish a harmonious balance between health and the illness experience of a person, which is essentially, by considering cost and quality of care, is the purpose of this study. Nursing, according to Watson's theory is considered to be a humanitarian science and it is characterized as being a profession that performs scientific, personal, ethical, and aesthetical practice (Ozan et al., 2015). This theory is therefore considered well suited for this research, more so because it specific to people and it accepts that various dimensions of human integrity while at the same time taking into account the mind-body spirit.

Methodology

A quantitative methodological design will be adopted for this study. The study will be a retrospective analysis based on ecological framework targeting inpatients being managed by NP and physicians. This design will be adopted because of the ecological nature of the study as stipulated by Watson's theory of Human Caring. The study will target a specific population of patients to gauge their views on the costs and quality of care provided by NP and how the same compares to care by physicians, under the same measure metrics. Research interviews will be used for data collection with researcher-filled questionnaires being used to guide the interview session (Allen et al., 2014).

Sampling plan

The study will be conducted in five different hospitals that have health services being provided by both NP and physicians. The hospitals will be selected based on suitability of access. To get a clear and relevant view of the costs and quality of services provided by NP, the study will target inpatients, preferably, those who have received healthcare services from both NP and physicians. Nevertheless, the study will also include those who have been treated by either NP or physician. In overall, the qualifications for inclusion in the study sample are;

• An individual who is 18 years and above.

• An inpatient who have been treated by a NP or a physicians for a period of time not less than five weeks (with the physicians seeing the patient at least once per week)

• A person of good and stable mental health capable of making sound decisions.

Study participants will be selected from hospital databases with the help of hospital staff to establish which patients will be more suited for the study. Classification will be done for patients being treated by a NP, a physician, or both. The study will target to have at least ten participants from each of the five hospitals.

Instrumentation and procedure

Research questionnaires will be used for data collections. The questionnaires have been designed based on information gathered from the literature review done. The questionnaires have an ethnographic section for capturing the patient's demographic details, and open ended questions on experiences of the patient pertaining cost and the quality of care (Allen et al., 2014; Kapu et al., 2014). The questionnaires will be administered by the researcher or left for the patient to fill depending on the health status, and the preferences of the interviewee.

Before the study is initiated, the researcher will seek for permission from the hospital management. The researcher will in charge of the data collection initiative. Patients who have been pre-established as being potential study participants will be approached for approval. The research will approach these patients one at a time in the company of a hospital staff, explain the objective of the study, what is needed from the patient, confidentially of the patient and the data to be collected, and the rights of the patients in participating in the study. Once a patient approves, the questionnaire will be administered. For patients who are treated by both a NP and a physician, the interview will be based on the treatment received as the distinguishing feature. For patients who are treated by either a NP or a physician, the researcher will mark the questionnaire accordingly for identification purposes.