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. 2012 Apr;47(2):594-613.
doi: 10.1111/j.1475-6773.2011.01343.x. Epub 2011 Nov 8.

The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queueing analysis

Nan Liu  1 , Thomas D'Aunno
Affiliations

The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queueing analysis

Nan Liu et al. Health Serv Res. 2012 Apr.

Abstract

Objective: To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how.

Data sources and study design: The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings.

Principal findings: Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery.

Conclusions: The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model.

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Figures

Figure 1
Figure 1
Practice Models
Figure 2
Figure 2
Relative Cost-Efficiency of Model II versus Model I under Different Values of Substitution Ratio p and Referral Rate r (Relative Cost-Efficiency Is Defined as the Ratio of the Average Cost of Model II to That of Model I; Substitution Ratio p is the Percentage of the Office Visits First Handled by the NP; Referral Rate r is the Proportion of Patients Who Initially Come to See the NP and Then are Referred to the PCP.)
Figure 3
Figure 3
Productivity of Model II (Supervision Model) and Model III (Shared-Panel Model)
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