Monday, June 1, 2009

Comparative Effectiveness Study...

Alright, so I am back from sunny San Diego, had a good time at the annual AAPA conference. The HOD was relatively boring this year, and got to take in some of the sights.

I am about to undertake the monster, my Moby Dick, the whale that no one wants to deal with. I am about to do, and have submitted for IRB approval, a comparative effectiveness study evaluating the care provided by PA's, working autonomously, vs MD attendings. This, at least to my knowledge, has not been done in the ED setting before, and I am interested in examining the results.

In order to keep the study manageable, and in order to obtain good results, we will be limiting the study to 3 diagnoses.

1. Renal Stones
2. Thromboembolic Events
3. Asthma Excacerbations

I chose these 3 diagnoses, as they all have defined endpoints within the ED setting, and am interested in comparing clinical outcomes, ie; did the PA group treat the patients in the same manner as the physician group?, Were there any missed diagnoses? Was there an increase in complications? etc.etc.
Also, I want to examine the financial impact, ie; we claim to be more cost effective, but is the PA group ordering more tests, and/or unnecessary interventions when compared to the physician group, thereby negating the cost savings?

As my friend, and colleague James Cawley noted, you may find things that you might not like. Which, at least in my mind, is even more of a reason to do this. If we are NOT meeting benchmarks, then we need to know this.

May be interesting.

Also, we have one NP in the group, and she will be included in the study group as well.

1 comment:

sbestpa said...

While I was working in an ED in NC, I did a mini-study of PA care. In 1043 patients, comprised of patients with ESI(Emergency Severity Index)of 2-5, only 5 patients were discussed with the emergency attending. Of these 5, there were only 2 where the evaluation or care was altered by the attending, and in none (0) cases, was there any change in the patient disposition as a reult of the consultation or alteration in evaluation or care. While I was not comparing care of MD vs PA, it strongly implies that, for ESI 2-5 patients, PA consultation with an attending ED physician doesn't have any bearing on patient disposition or care. During the same time frame, the emergency attending physicians consulted a PA regarding the care of their patients 53 times. Just FYI, I'd really be interested in the results of your study when completed.