Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care. Issue 7 (July 2021)

• Record Type: Journal Article
• Authors: Gigli, Kristin H.; Davis, Billie S.; Martsolf, Grant R.; Kahn, Jeremy M.
• Is Part Of: Medical care. Volume 59:Issue 7(2021)
• Publication Date: 2021-07
• Subjects: advanced practice provider -- pediatric -- intensive care unit -- models of care -- outcomes assessment; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001531
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models. Objectives: We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs. Research Design: Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes. Measures: The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay. Results: The sample included 38, 788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83–1.81, P =0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59–0.98, P =0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61–0.86, P <0.001). There were no differences in lengths of stay. Conclusions: Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes. Abstract : Supplemental Digital Content is available in the text.