Impact of the advanced practice provider in adult critical care: a systematic review and meta-analysis

Herman G. Kreeftenberg (Corresponding author), Sjaak Pouwels, Alexander J.G.H. Bindels, Ashley de Bie, Peter H.J. van der Voort

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

OBJECTIVES: To evaluate the effects on quality and efficiency of implementation of the advanced practice provider in critical care. DATA SOURCES: PubMed, Embase, The Cochrane Library, and CINAHL were used to extract articles regarding advanced practice providers in critical care. STUDY SELECTION: Articles were selected when reporting a comparison between advanced practice providers and physician resident/fellows regarding the outcome measures of mortality, length of stay, or specific tasks. Descriptive studies without comparison were excluded. The methodological quality of the included studies was rated using the Newcastle-Ottawa scale. The agreement between the reviewers was assessed with Cohen's kappa. A meta-analysis was constructed on mortality and length of stay. DATA EXTRACTION AND SYNTHESIS: One-hundred fifty-six studies were assessed by full text. Thirty comparative cohort studies were selected and analyzed. These compared advanced practice providers with physician resident/fellows. All studies comprised adult intensive care. Most of the included studies showed a moderate to good quality. Over time, the study designs advanced from retrospective designs to include prospective and comparative designs. DATA SYNTHESIS: Four random effects meta-analyses on length of stay and mortality were constructed from the available studies. These meta-analyses showed no significant difference between performance of advanced practice providers on the ICU and physician residents/fellows on the ICU, suggesting the quality of care of both groups was equal. Mean difference for length of stay on the ICU was 0.34 (95% CI, -0.31 to 1.00; I = 99%) and for in hospital length of stay 0.02 (95% CI, -0.85 to 0.89; I = 91%); whereas the odds ratio for ICU mortality was 0.98 (95% CI, 0.81-1.19; I = 37.3%) and for hospital mortality 0.92 (95% CI, 0.79-1.07; I = 28%). CONCLUSIONS: This review and meta-analysis shows no differences between acute care given by advanced practice providers compared with physician resident/fellows measured as length of stay or mortality. However, advanced practice providers might add value to care in several other ways, but this needs further study.

LanguageEnglish
Pages722-730
Number of pages9
JournalCritical Care Medicine
Volume47
Issue number5
DOIs
StatePublished - 1 May 2019

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Critical Care
Meta-Analysis
Length of Stay
Mortality
Physicians
Quality of Health Care
Hospital Mortality
PubMed
Libraries
Cohort Studies
Odds Ratio
Outcome Assessment (Health Care)

Cite this

Kreeftenberg, H. G., Pouwels, S., Bindels, A. J. G. H., de Bie, A., & van der Voort, P. H. J. (2019). Impact of the advanced practice provider in adult critical care: a systematic review and meta-analysis. Critical Care Medicine, 47(5), 722-730. DOI: 10.1097/CCM.0000000000003667
Kreeftenberg, Herman G. ; Pouwels, Sjaak ; Bindels, Alexander J.G.H. ; de Bie, Ashley ; van der Voort, Peter H.J./ Impact of the advanced practice provider in adult critical care : a systematic review and meta-analysis. In: Critical Care Medicine. 2019 ; Vol. 47, No. 5. pp. 722-730
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Kreeftenberg, HG, Pouwels, S, Bindels, AJGH, de Bie, A & van der Voort, PHJ 2019, 'Impact of the advanced practice provider in adult critical care: a systematic review and meta-analysis' Critical Care Medicine, vol. 47, no. 5, pp. 722-730. DOI: 10.1097/CCM.0000000000003667

Impact of the advanced practice provider in adult critical care : a systematic review and meta-analysis. / Kreeftenberg, Herman G. (Corresponding author); Pouwels, Sjaak; Bindels, Alexander J.G.H.; de Bie, Ashley; van der Voort, Peter H.J.

In: Critical Care Medicine, Vol. 47, No. 5, 01.05.2019, p. 722-730.

Research output: Contribution to journalArticleAcademicpeer-review

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AB - OBJECTIVES: To evaluate the effects on quality and efficiency of implementation of the advanced practice provider in critical care. DATA SOURCES: PubMed, Embase, The Cochrane Library, and CINAHL were used to extract articles regarding advanced practice providers in critical care. STUDY SELECTION: Articles were selected when reporting a comparison between advanced practice providers and physician resident/fellows regarding the outcome measures of mortality, length of stay, or specific tasks. Descriptive studies without comparison were excluded. The methodological quality of the included studies was rated using the Newcastle-Ottawa scale. The agreement between the reviewers was assessed with Cohen's kappa. A meta-analysis was constructed on mortality and length of stay. DATA EXTRACTION AND SYNTHESIS: One-hundred fifty-six studies were assessed by full text. Thirty comparative cohort studies were selected and analyzed. These compared advanced practice providers with physician resident/fellows. All studies comprised adult intensive care. Most of the included studies showed a moderate to good quality. Over time, the study designs advanced from retrospective designs to include prospective and comparative designs. DATA SYNTHESIS: Four random effects meta-analyses on length of stay and mortality were constructed from the available studies. These meta-analyses showed no significant difference between performance of advanced practice providers on the ICU and physician residents/fellows on the ICU, suggesting the quality of care of both groups was equal. Mean difference for length of stay on the ICU was 0.34 (95% CI, -0.31 to 1.00; I = 99%) and for in hospital length of stay 0.02 (95% CI, -0.85 to 0.89; I = 91%); whereas the odds ratio for ICU mortality was 0.98 (95% CI, 0.81-1.19; I = 37.3%) and for hospital mortality 0.92 (95% CI, 0.79-1.07; I = 28%). CONCLUSIONS: This review and meta-analysis shows no differences between acute care given by advanced practice providers compared with physician resident/fellows measured as length of stay or mortality. However, advanced practice providers might add value to care in several other ways, but this needs further study.

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Kreeftenberg HG, Pouwels S, Bindels AJGH, de Bie A, van der Voort PHJ. Impact of the advanced practice provider in adult critical care: a systematic review and meta-analysis. Critical Care Medicine. 2019 May 1;47(5):722-730. Available from, DOI: 10.1097/CCM.0000000000003667