A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?
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-effectiv...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Nursing Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2014/896587 |
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| author | Faith Donald Kelley Kilpatrick Kim Reid Nancy Carter Ruth Martin-Misener Denise Bryant-Lukosius Patricia Harbman Sharon Kaasalainen Deborah A. Marshall Renee Charbonneau-Smith Erin E. Donald Monique Lloyd Abigail Wickson-Griffiths Jennifer Yost Pamela Baxter Esther Sangster-Gormley Pamela Hubley Célyne Laflamme Marsha Campbell–Yeo Sheri Price Jennifer Boyko Alba DiCenso |
| author_facet | Faith Donald Kelley Kilpatrick Kim Reid Nancy Carter Ruth Martin-Misener Denise Bryant-Lukosius Patricia Harbman Sharon Kaasalainen Deborah A. Marshall Renee Charbonneau-Smith Erin E. Donald Monique Lloyd Abigail Wickson-Griffiths Jennifer Yost Pamela Baxter Esther Sangster-Gormley Pamela Hubley Célyne Laflamme Marsha Campbell–Yeo Sheri Price Jennifer Boyko Alba DiCenso |
| author_sort | Faith Donald |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-28895365db284044a45174fcd5b5168e |
| institution | Kabale University |
| issn | 2090-1429 2090-1437 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Nursing Research and Practice |
| spelling | doaj-art-28895365db284044a45174fcd5b5168e2025-02-03T07:24:44ZengWileyNursing Research and Practice2090-14292090-14372014-01-01201410.1155/2014/896587896587A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?Faith Donald0Kelley Kilpatrick1Kim Reid2Nancy Carter3Ruth Martin-Misener4Denise Bryant-Lukosius5Patricia Harbman6Sharon Kaasalainen7Deborah A. Marshall8Renee Charbonneau-Smith9Erin E. Donald10Monique Lloyd11Abigail Wickson-Griffiths12Jennifer Yost13Pamela Baxter14Esther Sangster-Gormley15Pamela Hubley16Célyne Laflamme17Marsha Campbell–Yeo18Sheri Price19Jennifer Boyko20Alba DiCenso21Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, CanadaFaculty of Nursing, Université de Montreal and Research Centre of Hôpital Maisonneuve-Rosemont, CSA-RC-Aile Bleue-Room F121, 5415 boulevard l’Assomption, Montréal, QC, H1T 2M4, CanadaKJ Research, Rosemere, QC, J7A 4N8, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaSchool of Nursing, Dalhousie University, Box 15000, 5869 University Avenue, Halifax, NS, B3H 4R2, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaDepartment of Community Health Sciences, Faculty of Medicine, University of Calgary, Health Research Innovation Centre, Room 3C56, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaFraser Health Authority, Suite 400-13450 102nd Avenue, Surrey, BC, V3T 0H1, CanadaInternational Affairs and Best Practice Guidelines Centre, Registered Nurses’ Association of Ontario, 158 Pearl Street, Toronto, ON, M5H 1L3, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaSchool of Nursing, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC, V8W 2Y2, CanadaThe Hospital for Sick Children, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, CanadaPrimary Health Care Nurse Practitioner Program, School of Nursing, University of Ottawa, 600 Peter Morand Crescent, Suite 101, Ottawa, ON, K1G 5Z3, CanadaSchool of Nursing, Dalhousie University, Box 15000, 5869 University Avenue, Halifax, NS, B3H 4R2, CanadaSchool of Nursing, Dalhousie University, Box 15000, 5869 University Avenue, Halifax, NS, B3H 4R2, CanadaSchool of Health Studies, Western University, Health Sciences Building, Room 403, London, ON, N6A 5B9, CanadaSchool of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, CanadaBackground. 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.http://dx.doi.org/10.1155/2014/896587 |
| spellingShingle | Faith Donald Kelley Kilpatrick Kim Reid Nancy Carter Ruth Martin-Misener Denise Bryant-Lukosius Patricia Harbman Sharon Kaasalainen Deborah A. Marshall Renee Charbonneau-Smith Erin E. Donald Monique Lloyd Abigail Wickson-Griffiths Jennifer Yost Pamela Baxter Esther Sangster-Gormley Pamela Hubley Célyne Laflamme Marsha Campbell–Yeo Sheri Price Jennifer Boyko Alba DiCenso A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence? Nursing Research and Practice |
| title | A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence? |
| title_full | A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence? |
| title_fullStr | A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence? |
| title_full_unstemmed | A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence? |
| title_short | A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence? |
| title_sort | systematic review of the cost effectiveness of nurse practitioners and clinical nurse specialists what is the quality of the evidence |
| url | http://dx.doi.org/10.1155/2014/896587 |
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