title: Nurse practitioners as attending providers for injured workers: evaluating the effect of role expansion on disability and costs.
abstract: BACKGROUND
  A 3-year pilot program to expand the role of nurse practitioners (NPs) in the Washington State workers' compensation system was implemented on July 1, 2004. This legislation authorized NPs to independently perform most functions of an attending physician.
  
  
  OBJECTIVE
  The purpose of this study was to assess the impact of this legislation by examining medical costs and disability outcomes for injured workers in the care of NPs benchmarked against those in the care of primary care physicians (PCPs).
  
  
  METHODS
  This observational study compared NPs and PCPs in the role of attending provider based on the medical costs and disability outcomes of injured workers in their care. Comparisons controlled for sociodemographics, geographic location, injury, employment, and provider characteristics.
  
  
  METHODS
  The Washington State Department of Labor and Industries provided claim and medical billing data for 29,949 injured workers who had an accident report filed by an NP or PCP between July 1, 2004 and June 30, 2005. Data were collected through June 30, 2006.
  
  
  RESULTS
  NPs were more likely than PCPs to be located in rural areas and counties with high unemployment. The distributions of injury type and severity/complexity indicators were similar across provider types. The likelihood of any time loss was lower for NP claims, but duration of lost work time and medical costs did not significantly differ by provider type.
  
  
  CONCLUSIONS
  Attending provider type is not a significant predictor of disability or medical costs for injured workers in Washington State.
authors.affiliation: Department of Health Services, School of Nursing, University of Washington, Seattle, Washington 98195, USA. jeannes@u.washington.edu
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Sears
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Wickizer
authors.forename: Gary M
authors.initials: GM
authors.lastname: Franklin
authors.forename: Allen D
authors.initials: AD
authors.lastname: Cheadle
authors.forename: Bobbie
authors.initials: B
authors.lastname: Berkowitz
mesh_terms: D000062:Accidents, Occupational / Q000191:economics* / Q000331:legislation & jurisprudence; D000293:Adolescent; D000328:Adult; D000368:Aged; D006233:Persons with Disabilities; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D024802:Nurse's Role; D010821:Physicians, Family; D012044:Regression Analysis; D014942:Workers' Compensation / Q000331:legislation & jurisprudence / Q000458:organization & administration*