In the University Hospitals of Cleveland's Collaborative Care Unit, nurse practitioners manage the delivery of care and clinical decision-making. This project examined the impact of the collaborative care model on costs and quality of care at the hospital using a randomized controlled trial over a two-year period.
The investigators collected a wide range of outcome measures through patient interviews and medical record reviews, including functional status, symptom severity, patient satisfaction, mortality, hospital-acquired complications, use of consultations and hospital costs.
This project was part of the Robert Wood Johnson Foundation (RWJF) national program Changes in Health Care Financing and Organization (HCFO).
Patient outcomes were similar on the collaborative care unit and traditional care units. According to the researchers, this finding suggests that nurse practitioners can successfully manage a wider spectrum of patients, and teaching hospitals can implement collaborative care, using nurse practitioners in an advanced role, without fear that the quality of care will suffer.
Patients whose care requires 24-hour monitoring and patients with undifferentiated or unclear admitting diagnoses would be best cared for on a traditional unit, under the care of resident physicians. However, these patients comprise only a small portion of patients admitted to the general medical wards of teaching hospitals.
The study team also noted that increased use of mid-level practitioners within academic medical centers would leave resident physicians with more time to pursue their educational objectives, particularly in the area of ambulatory care.