Cost-effectiveness of a nurse practitioner-family physician model of care in a nursing home: controlled before and after study.
J Adv Nurs
; 72(9): 2138-52, 2016 Sep.
Article
in En
| MEDLINE
| ID: mdl-27119440
ABSTRACT
AIMS:
To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home.BACKGROUND:
As demand for long-term care increases, alternative care models including nurse practitioners are being explored.DESIGN:
Cost-effectiveness analysis using a controlled before-after design.METHODS:
The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves.RESULTS:
Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%.CONCLUSION:
Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Physicians, Family
/
Nurse Practitioners
/
Nursing Homes
Type of study:
Health_economic_evaluation
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
J Adv Nurs
Year:
2016
Type:
Article
Affiliation country:
Canada