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Advanced Practice Providers Use ED Resources Similarly to Physicians

WEDNESDAY, Feb 10, 2021 -- Use of diagnostic resources and admissions in emergency department patients with chest or abdominal pain are similar regardless of treatment by an advanced practice provider (APP) or a physician, according to a study published in the January issue of Academic Emergency Medicine.

Jesse M. Pines, M.D., from U.S. Acute Care Solutions in Canton, Ohio, and colleagues compared utilization of diagnostic resources and admissions in emergency department patients (2016 to 2019) with chest pain and abdominal pain when managed by APPs and physicians.

The researchers identified 77,568 visits for patients with chest pain seen by 1,011 APPs and 586,031 visits for patients seen by 1,588 physicians, as well as 184,812 visits for abdominal pain in patients seen by 1,080 APPs and 761,230 visits for patients seen by 1,689 physicians. Overall, for both conditions, physicians saw more older adult patients (55 years and older) and admitted a higher percentage of visits than APPs. Among patients with chest pain, physicians saw more circulatory system diseases (70.7 versus 58.6 percent), while APPs saw more respiratory system diseases (17.1 versus 9.8 percent). Among patients with abdominal pain, emergency physicians saw more digestive system diseases (28.5 versus 23.3 percent), while APPs saw more genitourinary system diseases. Predicted probabilities of laboratory, radiology, and admissions either did not vary or were slightly lower for APPs versus physicians for all outcomes when using inverse propensity score weights. Results were similar when controlling for past medical history.

"This suggests that APPs do not have observably higher use of emergency department and hospital resources in these conditions in this national group," the authors write.

One author disclosed financial ties to pharmaceutical and medical technology companies.

Abstract/Full Text

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