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Cited by 955Nursing Roles and PracticesPrimary Care and Health OutcomesEmergency and Acute Care Studies

Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial

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Mundinger, Mary O., Kane, Robert L., Lenz, Elizabeth R., Totten, Annette M., Tsai, Wei-Yann, Cleary, Paul D., Friedewald, William T., Siu, Albert L. +1 more·2000·JAMA
DOI 10.1001/jama.283.1.59
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Abstract

CONTEXT: Studies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians. However, these studies did not measure nurse practitioner practices that had the same degree of independence as the comparison physician practices, nor did previous studies provide direct comparison of outcomes for patients with nurse practitioner or physician providers. OBJECTIVE: To compare outcomes for patients randomly assigned to nurse practitioners or physicians for primary care follow-up and ongoing care after an emergency department or urgent care visit. DESIGN: Randomized trial conducted between August 1995 and October 1997, with patient interviews at 6 months after initial appointment and health services utilization data recorded at 6 months and 1 year after initial appointment. SETTING: Four community-based primary care clinics (17 physicians) and 1 primary care clinic (7 nurse practitioners) at an urban academic medical center. PATIENTS: Of 3397 adults originally screened, 1316 patients (mean age, 45.9 years; 76.8% female; 90.3% Hispanic) who had no regular source of care and kept their initial primary care appointment were enrolled and randomized with either a nurse practitioner (n = 806) or physician (n = 510). MAIN OUTCOME MEASURES: Patient satisfaction after initial appointment (based on 15-item questionnaire); health status (Medical Outcomes Study Short-Form 36), satisfaction, and physiologic test results 6 months later; and service utilization (obtained from computer records) for 1 year after initial appointment, compared by type of provider. RESULTS: No significant differences were found in patients' health status (nurse practitioners vs physicians) at 6 months (P = .92). Physiologic test results for patients with diabetes (P = .82) or asthma (P = .77) were not different. For patients with hypertension, the diastolic value was statistically significantly lower for nurse practitioner patients (82 vs 85 mm Hg; P = .04). No significant differences were found in health services utilization after either 6 months or 1 year. There were no differences in satisfaction ratings following the initial appointment (P = .88 for overall satisfaction). Satisfaction ratings at 6 months differed for 1 of 4 dimensions measured (provider attributes), with physicians rated higher (4.2 vs 4.1 on a scale where 5 = excellent; P = .05). CONCLUSIONS: In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients' outcomes were comparable.

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  • Measurable clinical outcomes are systematically found to be equivalent to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.

    “Measurable clinical outcomes are systematically found to be equivalent11,18,19,23,27-32 to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.11,19,21,26,27,29,30,33,34”

    From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [32]

    The COMMENT section reports similar clinical outcomes for nurse-practitioner and physician patients in this trial, supporting the clinical-outcomes portion, though one trial does not establish that equivalence is systematically found. The Satisfaction section does not support higher satisfaction with nurse-provided care: most measures showed no significant difference, and the only significant difference favored physicians. (LLM, conf=0.89)

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Research works printed but not linked: 4

  1. Safriet BJ. Health care dollars and regulatory sense. Yale J Regul. 1992;9:417-488.
  2. Ware JE Jr, Bayliss MS, Rogers WH, Kosinski M, Tar- lov AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. JAMA. 1996;276:1039-1047.
  3. Deyo RA, Inui TS. Dropouts and broken appoint- ments: a literature review and agenda for future re- search. Med Care. 1980;18:1146-1157.
  4. Vikander T, Parnicky K, Demers R, Frisof K, Dem- ers P, Chase N. New-patient no-shows in an urban fam- ily practice center. J Fam Pract. 1986;22:263-268.

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Authors
Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W.-Y., Cleary, P. D., Friedewald, W. T., Siu, A. L., & Shelanski, M. L.
Affiliations
  • Columbia University (US)
  • University of Minnesota (US)
  • Harvard University (US)
  • MetLife (United States) (US)
  • Icahn School of Medicine at Mount Sinai (US)
Corresponding author
Mundinger, Mary O.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2000-01-05
Volume
283
Issue
1
Pages
59
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.283.1.59
OpenAlex
W2031048019
Cited by
955
References
26
Citations by year
2026: 4 · 2025: 25 · 2024: 15 · 2023: 10 · 2022: 17 · 2021: 23 · 2020: 20 · 2019: 28 · 2018: 34 · 2017: 24 · 2016: 40 · 2015: 51 · 2014: 32 · 2013: 46 · 2012: 44
FWCI
143.66
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
nurse practitioners, physician care, primary care quality, patient satisfaction, health status, health care utilization, hypertension control, diabetes mellitus, asthma, emergency department follow-up, outpatient care, Hispanic patients, racial disparities in health care, managed care, health professions workforce, health professions research
MeSH terms
Adult, Ambulatory Care, Community Health Centers, Continuity of Patient Care, Emergencies, Female, Health Services Research, Health Status, Humans, Male, Middle Aged, New York City, Nurse Practitioners, Physicians, Family, Primary Health Care, Regression Analysis, Professional Autonomy, Patient Satisfaction, Outcome Assessment, Health Care

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