Physician's extenders' performance in Air Force clinics.
We evaluated the quality of care of physician's extenders (PEs: 23 physician's assistants, 7 primary care nurse practitioners) in Air Force primary medicine clinics, as part of an evaluation of PEs' assuming a considerable portion of the care, formerly provided by physicians in the military medical system. Physician's assistants performed at least as well as physicians on 25 out of 28 nonredundant process-of-care criteria; nurse practitioners met the physicians' standard on 14 of 19 criteria. In a comparison of physician's assistants with nurse practitioners, the two groups' performance was not significantly different. No major differences were found in PEs' and physicians' use of ancillary services (laboratory, x-ray, physical therapy) or orders for further care. As expected, PEs consulted physicians infrequently, but more often for serious complaints and at rates similar to those found in a civilian HMO setting. We conclude that the Air Force can deliver the same quality of care when PEs treat a sizable proportion of patients formerly treated by physicians.
D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D006772:Hospitals, Military; D006779:Hospitals, Public; D006801:Humans; D009722:Nurse Practitioners; D010823:Physician Assistants; D011320:Primary Health Care / Q000458:organization & administration; D013647:Task Performance and Analysis; D014481:United States; D000078329:Workforce