Project Summary
Elderly patients are particularly susceptible to complications after major surgery, with rates
approaching 35%. Such complications threaten independence and carry a higher risk of death,
underscoring the importance of careful coordination of care in this population. With ongoing
shortages of surgeons across multiple disciplines, some surgical practices have incorporated
nurse practitioners (NPs) and physician assistants (PAs) who provide the flexibility of
functioning in both the inpatient and outpatient settings. One advantage of this approach
includes improved access to the operating room (e.g., by allowing surgeons to perform
procedures more efficiently) and clinic (e.g., by offloading selected patient visits). Additionally,
this delivery model can enhance care coordination during the index hospitalization, and between
the inpatient and outpatient settings, which may improve surgical outcomes. Potential
disadvantages of this model relate to the relative inexperience of NPs and PAs with respect to
postoperative care, which may result in delayed complication recognition, and the possibility of
increased resource use (e.g., through greater use of diagnostic testing and/or consulting
physicians). This project comprehensively assesses these issues using national Medicare data
and has the following aims: 1) Measure the impact of integration of NPs and PAs into single-
specialty surgical practice on access to care for patients with Medicare; 2) Determine the impact
of integration of NPs and PAs into single-specialty surgical practice on surgical outcomes; and,
3) Assess the impact of NP and PA integration on practices that disproportionately care for
vulnerable Medicare patients. Findings from this study will shed light on how NPs and PAs can
be utilized to improve surgical access and outcomes in Medicare patients, and certain
vulnerable populations in particular. Furthermore, the project will directly inform policymakers,
health system leaders, professional societies and surgeons about the effects of NP/PA
expansion on surgical care in the elderly.