Observational studyBMJ open2017
The involvement of physician assistants in inpatient care in hospitals in the Netherlands: a cost-effectiveness analysis.
Observational study in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01835444 (Worthy Assistants), which is not on this map. Cited by 15 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Worthy Assistants: Does Substituting Hospital Ward Care From Medical Residents to Physician Assistants Result in Cost Savings?
Who cites it
15 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review.BMC health services research · 2025Pooled it
- Impact of physician assistants on quality of care: rapid review.BMJ (Clinical research ed.) · 2025Pooled it
- The cost-effectiveness of physician assistants/associates: A systematic review of international evidence.PloS one · 2021Pooled it
- Contribution of physician assistants/associates to secondary care: a systematic review.BMJ open · 2018Pooled it
- Developing and integrating physician assistants/associates in UK hospital teams: a realist review of lessons from international experiences.BMC medicine · 2025Review
- Are Economic Evaluations of Task Shifting Too Narrow in Focus? A Rapid Review.PharmacoEconomics · 2025Review
- Understanding the scope of practice of physician associate/physician associate comparable professions using the World Health Organization global competency and outcomes framework for universal health coverage.Human resources for health · 2023Article
- The influence of government policies on the nurse practitioner and physician assistant workforce in the Netherlands, 2000-2022: a multimethod approach study.BMC health services research · 2023Review
- A comparison of surgical outcomes among robotic cases performed with an employed surgical assist versus a second surgeon as the assist.Journal of robotic surgery · 2022Article
- How we adapted the T&O inpatient service during the COVID-19 pandemic with physician associates to support the orthopaedic team.Future healthcare journal · 2021Article
- Risk aversion, trust in institutions and contingent valuation of healthcare services: trying to explain the WTA-WTP gap in the Dutch population.Cost effectiveness and resource allocation : C/E · 2021Article
- Article
- An activity analysis of Dutch hospital-based physician assistants and nurse practitioners.Human resources for health · 2019Article
- What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study.BMJ open · 2019Article
- Effective coverage and budget implications of skill-mix change to improve neonatal nursing care: an explorative simulation study in Kenya.BMJ global health · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate the cost-effectiveness of substitution of inpatient care from medical doctors (MDs) to physician assistants (PAs).
designCost-effectiveness analysis embedded within a multicentre, matched-controlled study. The traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which, besides MDs, PAs are also employed (PA/MD model).
setting34 hospital wards across the Netherlands.
participants2292 patients were followed from admission until 1 month after discharge. Patients receiving daycare, terminally ill patients and children were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: All direct healthcare costs from day of admission until 1 month after discharge. Health outcome concerned quality-adjusted life years (QALYs), which was measured with the EuroQol five dimensions questionnaire (EQ-5D).
resultsWe found no significant difference for QALY gain (+0.02, 95% CI -0.01 to 0.05) when comparing the PA/MD model with the MD model. Total costs per patient did not significantly differ between the groups (+€568, 95% CI -€254 to €1391, p=0.175). Regarding the costs per item, a difference of €309 per patient (95% CI €29 to €588, p=0.030) was found in favour of the MD model regarding length of stay. Personnel costs per patient for the provider who is primarily responsible for medical care on the ward were lower on the wards in the PA/MD model (-€11, 95% CI -€16 to -€6, p<0.01).
conclusionsThis study suggests that the cost-effectiveness on wards managed by PAs, in collaboration with MDs, is similar to the care on wards with traditional house staffing. The involvement of PAs may reduce personnel costs, but not overall healthcare costs. TRIAL REGISTRATION NUMBER: NCT01835444.
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