Nurse Practitioner Impact on Quantitative Patient Outcomes in Four Healthcare Settings' System Context: A Systematic Review and Meta-Analysis

Abstract

Nurse Practitioners (NPs) are frequently integrated into interprofessional teams to improve quality and efficiency of healthcare delivery, especially in complex systems. Research on the NP role has grown dramatically, yet an aggregate analysis had never been performed. The purpose of this review was to systematically describe the nature and impact of NP interventions in healthcare settings, to establish a comprehensive understanding of NPs with respect to healthcare delivery, including discovery of information gaps. The specific objectives of the study were to describe the types of: 1) intervention activities that NPs have performed in randomised controlled trials (RCTs); 2) quantitative study endpoints measured in RCTs; and 3) impact of NPs on all quantitative patient outcomes in four settings: primary health care, long term care, outpatient care, and acute care, conducting meta-analysis where possible. Eligible studies included low risk of bias RCTs that tested NP interventions on quantitative endpoints in healthcare settings; data sources included peer reviewed or grey literature in English, from the year 2000 forth. The literature search performed by a professional librarian (MH) yielded 1,188 unique citations. Screening for relevance and risk of bias by two independent reviewers (LT and NL) resulted in a set of included studies comprised of 39 articles (29 different RCTs). Data extraction by LT was cross-checked by the second independent reviewer NL. Findings were systematically summarized according to pre-specified protocol. Out of 89 classes of endpoint-outcomes, results for 43 patient outcome classes (43/89; 48%) were statistically significant, associated with 26/29 (90%) interventions. Meta-analysis was conducted to compare the proportion of hospitalizations between intervention and control groups of two homogenous studies, systematically completing the review’s data analysis. Transparent data presentation within an explicit, reproducible methodology minimizes bias, resulting in reliable findings that were organized, synthesized and summarized in a clear and comprehensive fashion. To the extent of its findings, this systematic review may support improvements in access to quality healthcare, and may provide insight into long term strategies that have potential to contribute toward enhanced balance within the healthcare continuum, from delivery of preventive primary health care services to treatment in acute care.