title: Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals.
abstract: BACKGROUND
  Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine.
  
  
  OBJECTIVE
  Describe APPs role in inpatient medicine.
  
  
  METHODS
  Observational cross-sectional cohort study.
  
  
  METHODS
  One hundred twenty-four Veterans Health Administration (VHA) hospitals.
  
  
  METHODS
  Chiefs of medicine (COMs) and nurse managers.
  
  
  METHODS
  Surveys included inpatient medicine scope of practice for APPs and perceived healthcare quality. We conducted bivariate unadjusted and multivariable adjusted analyses.
  
  
  RESULTS
  One hundred eighteen COMs (95.2%) and 198 nurse managers (75.0%) completed surveys. Of 118 medicine services, 56 (47.5%) employed APPs; 27 (48.2%) used NPs only, 15 (26.8%) PAs only, and 14 (25.0%) used both. Full-time equivalents for NPs was 0.5 to 7 (mean = 2.22) and PAs was 1 to 9 (mean = 2.23). Daily caseload was similar at 4 to 10 patients (mean = 6.5 patients). There were few significant differences between tasks. The presence of APPs was not associated with patient or nurse manager satisfaction. Presence of NPs was associated with greater overall inpatient and discharge coordination ratings by COMs and nurse managers, respectively; the presence of PAs was associated with lower overall inpatient coordination ratings by nurse managers.
  
  
  CONCLUSIONS
  NPs and PAs work on half of VHA inpatient medicine services with broad, yet similar, scopes of practice. There were few differences between their roles and perceptions of care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs.
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR) at the VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Anand
authors.initials: A
authors.lastname: Kartha
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Restuccia
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.forename: Justin
authors.initials: J
authors.lastname: Benzer
authors.forename: Justin
authors.initials: J
authors.lastname: Glasgow
authors.forename: Jason
authors.initials: J
authors.lastname: Hockenberry
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kaboli
mesh_terms: D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D009722:Nurse Practitioners / Q000458:organization & administration* / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling; D010564:Personnel, Hospital; D010823:Physician Assistants / Q000458:organization & administration* / Q000706:statistics & numerical data*; D024382:Professional Role; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D016526:Workload