Mary O. Mundinger

Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up

This study reports results of the 2-year follow-up phase of a randomized study comparing outcomes of patients assigned to a nurse practitioner or a physician primary care practice. In the sample of 406 adults, no differences were found between the groups in health status, disease-specific physiologic measures, satisfaction or use of specialist, emergency room or inpatient services. Physician patients averaged more primary care visits than nurse practitioner patients. The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians.

Diabetes care processes and outcomes in patients treated by nurse practitioners or physicians.

PURPOSE the purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners (NPs) and physicians (MDs) in the primary care of adults with type 2 diabetes. METHODS Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and randomized to an NP or MD practice. Chart reviews were conducted to assess processes of care; patient interviews and hemoglobin Al C (Al C) testing were performed to measure patient outcomes. RESULTS NPs were more likely than MDs to document provision of general diabetes education and education about nutrition, weight, exercise, and medications. They were more likely to document patient height, urinalyses results, and Al C values. No differences were found in documenting current medications; alcohol, illicit drug, or tobacco use; depression; weight and blood pressure; foot and cardiovascular exams; blood glucose and creatinine testing; or referral to ophthalmologists. No differences were found in patient outcomes. CONCLUSIONS This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes. NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs; however, these differences were not reflected in 6-month patient outcomes.

The ABCs of the Doctor of Nursing Practice: Assessing Resources, Building a Culture of Clinical Scholarship, Curricular Models

The Doctor of Nursing Practice (DNP) degree prepares nurses to provide comprehensive care across sites and over time. It is absolutely crucial-for both patient care and the nursing profession-that broadly recognized standards of competency for these new practitioners be established. The Council for the Advancement of Comprehensive Care has met since 2000 to build consensus on competency standards and a process for certifying these graduates. Deans of five nursing schools discuss their experiences and provide guidance for schools interested in developing DNP programs.

Diagnostic Utility of an Epilepsy Monitoring Unit

Guidelines recommend that patients with persistent seizures not responsive to standard antiepileptic drugs after 1 year be referred to specialized epilepsy centers for evaluation, which may include inpatient video-electroencephalographic monitoring. This 1-year retrospective, limited-focus review of 213 admissions and 3-year postdischarge review of epilepsy surgery referrals sought to determine if admission to an inpatient adult epilepsy monitoring unit resulted in a definitive diagnosis, a change in diagnosis or treatment, and whether referral patterns were consistent with guidelines. The median duration of time since symptom onset prior to admission was 15 years. At discharge, 87.8% of admissions received a definitive diagnosis. Epilepsy was diagnosed in 73.3% and excluded in 21.6%. Admissions without epilepsy had been treated with antiepileptic drugs for a median of 9 years. Admission resulted in change in treatment in 79%. This review documents the diagnostic utility of an epilepsy monitoring unit while highlighting that time since symptom onset to admission exceeded established guidelines. (Am J Med Qual 2007;22:117-122)

Three-dimensional nursing: new partnerships between service and education.

Schools of nursing face a dilemma today: more and better nurses are needed by society at a time when nursing education costs are rising and the applicant pool is shrinking. Fewer people are willing to commit to a career in nursing when other, more financially lucrative careers are available. While changing client care needs escalate, major employers of nurses have not offered acceptable reimbursement and working conditions. The distance between nursing education and nursing service seems to be widening. All of these national problems had a severe impact on the Columbia University School of Nursing. Two years ago, the faculty and administration embarked on a revitalization effort. This article discusses the evolution, configuration, and implementation of that effort. Issues addressed include recruitment, clinical precepting, faculty practice, research, and curriculum design. Additional discussion focuses on the process of change, response to revitalization efforts, and the problems of maintaining forward momentum.