313 Physician Assistant Scope of Practice 2015
HgbA1c goal of less than 7.5.265
Quality of care is dependent on access to care. 266 This notion is evident
in emergency medicine (“EM”), where patients must be seen quickly and
effectively. 267 A 2009 study showed that PA or NP involvement in the care
of EM patients significantly reduced the wait times, lengths of stay, and
proportion of patients who left without being seen. 268 Furthermore, at least
one study demonstrated that, a significant benefit of a PA visit as compared
to a physician visit is that the cost incurred from a PA visit is less than that
of a physician visit in the same setting, such as an emergency room. 269
Provider skill is paramount to quality of care. 270 Using a prospectively
collected database of patients undergoing cardiac catheterization, the outcomes of procedures performed by PAs were compared with those performed by cardiology physician fellows-in-training. 271 Class 3 and 4 heart
failure was more common in patients who underwent procedures by fellows
compared with those undergoing procedures by PAs. 272 PA cases tended to
be slightly faster with less fluoroscopic time. 273 The incidence of major
complications within twenty-four hours of the procedure was similar between the two groups. 274 The study demonstrates that trained and experienced PAs can perform diagnostic cardiac catheterization with very low
complication rates—similar to those of cardiology fellows-in-training. 275
Other procedural studies that involve high skill include colorectal cancer
screening using flexible sigmoidoscopies. 276 The Horton study analyzed
265. Id. (This means that PA and/or NP care results in better management of patients
with diabetes as lower HGBA1c is a marker for blood sugar control.).
266. See James Ducharme et al., The Impact on Patient Flow After The Integration of
Nurse Practitioners and Physician Assistants In 6 Ontario Emergency Departments, 11 CAN.
J. OF EMERGENCY. MED. CARE 455, 456 (2009) (“Delays in assessment and care may have
negative effects on patient care and outcomes.”).
268. Id. at 458 (“[W]hen a PA was involved in patient care the odds of the patient being
seen within the benchmark wait time was 1.6 times greater than when the PA was not involved. . . . When the NP was involved, the odds were 2.1 times greater.”).
269. Diana Dryer Wright et al., Costs and Outcomes for Different Primary Care Providers, 238 J. AM. MED. ASS’N 46, 46-50 (1977).
270. See Avedis Donabedian, The Quality of Care: How Can it be Assessed?, 260 J.
AM. MED. ASS’N, 1743, 1743 (1988) (“[T]here are two elements in the performance of practitioners: one technical and the other interpersonal.”).
271. Richard A. Krasuski et al., Trained and Supervised Physician Assistants Can Safely Perform Diagnostic Cardiac Catheterization With Coronary Angiography, 59
CATHETERIZATION & CARDIOVASCULAR INTERVEN TIONS 157, 158 (2003).
272. Id. at 158-59.
273. Id. at 159.
275. Id. at 160.
276. See generally Leah B. Sansbury et al., Physicians’ Use of Nonphysician
Healthcare Providers for Colorectal Cancer Screening, 25 AM. J. OF PREVENTIVE MED., 179,
179-86 (2003); Kimberlee Horton et al., Training of Nurse Practitioners and Physician As-