A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?
Open accessPublished version of a preprint
Abstract
Background . Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective . To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design . Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results . 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient ( n = 11 ), NP-transition ( n = 5 ), NP-inpatient ( n = 2 ), CNS-outpatient ( n = 11 ), CNS-transition ( n = 13 ), and CNS-inpatient ( n = 1 ). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions . We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.
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References 114 · Cited by 59
- Authors
- Donald, F., Kilpatrick, K., Reid, K., Carter, N., Martin-Misener, R., Bryant-Lukosius, D., Harbman, P., Kaasalainen, S., Marshall, D. A., Charbonneau-Smith, R., Donald, E. E., Lloyd, M., Wickson-Griffiths, A., Yost, J., Baxter, P., Sangster-Gormley, E., Hubley, P., Laflamme, C., Campbell–Yeo, M., Price, S., Boyko, J., & DiCenso, A.
- Affiliations
- Toronto Metropolitan University (CA)
- Hôpital Maisonneuve-Rosemont (CA)
- KJ Research, Rosemere, QC, Canada J7A 4N8
- McMaster University (CA)
- School of Nursing, Dalhousie University, Box 15000, 5869 University Avenue, Halifax, NS, Canada B3H 4R2
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4L8
- University of Calgary (CA)
- Fraser Health (CA)
- Registered Nurses' Association of Ontario (CA)
- School of Nursing, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC, Canada V8W 2Y2
- University of Toronto (CA)
- University of Ottawa (CA)
- Dalhousie University (CA)
- Western University (CA)
- Corresponding author
- Donald, Faith
- ORCID
- Donald, Faith
- Kilpatrick, Kelley
- Reid, Kim
- Carter, Nancy
- Bryant-Lukosius, Denise
- Harbman, Patricia
- Kaasalainen, Sharon
- Marshall, Deborah A.
- Charbonneau-Smith, Renee
- Donald, Erin E.
- Lloyd, Monique
- Wickson-Griffiths, Abigail
- Yost, Jennifer
- Baxter, Pamela
- Sangster-Gormley, Esther
- Price, Sheri
- Boyko, Jennifer
- DiCenso, Alba
- Venue
- Nursing Research and Practice
- Publisher
- Wiley
- Published
- 2014
- Volume
- 2014
- Pages
- 1-28
- ISSN
- 2090-1429 (ISSN-L)
- 2090-1437
- PMC
- PMC4167459
- OpenAlex
- W2069906295
- Cited by
- 59
- References
- 114
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 12 · 2020: 4 · 2019: 6 · 2018: 5 · 2017: 6 · 2016: 3 · 2015: 6 · 2014: 2
- FWCI
- 0.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nursing Research and Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Libraries and Cultural Resources (University of Calgary) (acceptedVersion, other-oa)
- TSpace (University of Toronto) (submittedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UVic’s Research and Learning Repository (University of Victoria) (submittedVersion)
- Libraries and Cultural Resources (University of Calgary) (submittedVersion, cc-by)
- Funders
- Ontario Ministry of Health and Long-Term Care
- Office of Nursing Policy in Health Canada
- Canadian Foundation for Healthcare Improvement
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Keywords
- nurse practitioners, clinical nurse specialists, cost-effectiveness, quality of evidence, risk of bias, randomized controlled trials, health resource utilization, outpatient care, inpatient care, care transitions
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