The article starts by exploring how the hospital-based health practitioners are slowly being replaced by physicians assistants.
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In this regard, the authors have provided different reasons for the development of this innovation in medical employment, such as the misdistribution of physicians causing service gaps; changes in the federal rules and regulations with regard to the issue of hospital reimbursements; new guidelines that seeks to restrict the working hours of the residents; reduced physician residents programs in such main medical fields as medicine, pediatrics, and surgery; and a reduction in foreign medical graduates in the GME (graduate medical education) program (Sunil & Choksi, 2009, p. 133) in the United States.
The purpose of this particular article was to help in describing a comparative assessment of the impact of substituting an internal medicine residency program with a hospitalist model that involves a physician assistant, on the outcomes of patients within a community hospital.
The methodology entailed a replacement of some 9.5 full-time attending physicians and some 30 residents house staff with 12.5 full-time attending physicians and 23 physician assistants.
With regard to the residency model, the physician assistants were deployed to the medical ICE, general medical floor unit, the coronary care unit, and the telemetry/monitored settings units, all on a rotational basis ((Sunil & Choksi, 2009, p. 135).
On the other hand, the medical residency model had an attending physician present on the medical floor to facilitate indirect supervision during the off-hours and to direct supervision when the teaching rounds were in progress.
The physician assistants-hospitalized model also had an attending physical on call to ensure that the physician assistants were directly supervised during the regular hours of duty. On the other hand, during the weekend or the off-hours, an attending physician would often be on call to facilitate the supervision.
In order to facilitate the conduction of the study, the researchers deemed it appropriate to collect prospective data on the 2 years time duration during which the hospitalists’ service- physician’s assistant was compared with the service-physician prospective data from the adjusted mortality of the medical residents’ model that had also been collected during the same 2 years period.
The study’s outcome measures included adverse events, mortality, patient satisfaction, readmissions, and documentation.
The medical residents models versus the physicians assistant-hospitalists resulted in the yielding of an index-adjusted mortality for case mix and all-cause of 0.019 versus a56/5458 (representing a 2.85 %), and 107/5508 (representing a further 1.94%), respectively.
The non-adverse event cases reported by the study were 5, while the adverse event cases were 9. On the other hand, the study reported a 64 versus 69 rate of readmission within time duration of 30 days. Further, the study also recorded a 95 versus 96% rate of patient satisfaction (Sunil & Choksi, 2009, p. 136).
Moreover, the study also reported an equivalent provision of quality care to the patients in the hospital in question by the hospitalists-physician assistants’ model.
During the hospitalists-physicians assistants’ model period, the study reported significantly lower case mix index and all-cause adjusted mortality. The study further provides a recommendation on the need to conduct further research into the areas under investigation before it can be replicated into other similar institutions.
On the other hand, the authors did not collect any intrinsic barriers that could have hindered the implementation of this particular study design and for this reason the study could as well be implemented in other institutions.
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Sunil Dhuper, S., & Choksi, S. (2009). Replacing an Academic Internal Medicine Residency Program With a Physician Assistant–Hospitalist Model: A Comparative Analysis Study. AM J Med Qual, 24(2),132-9