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Nurse Practitioners as Attending Providers for Workers With Uncomplicated Back Injuries: Using Administrative Data to Evaluate Quality and Process of Care

Sears, Jeanne M. PhD, MS, RN; Wickizer, Thomas M. PhD, MPH; Franklin, Gary M. MD, MPH; Cheadle, Allen D. PhD; Berkowitz, Bobbie PhD

Journal of Occupational and Environmental Medicine: August 2007 - Volume 49 - Issue 8 - p 900-908
doi: 10.1097/JOM.0b013e318124a90e
Original Articles

Objective: The objectives of this study were 1) to identify quality and process of care indicators available in administrative workers’ compensation data and to document their association with work disability outcomes, and 2) to use these indicators to assess whether nurse practitioners (NPs), recently authorized to serve as attending providers for injured workers in Washington State, performed differently than did primary care physicians (PCPs).

Methods: Quality and process of care indicators for NP and PCP back injury claims from Washington State were compared using direct standardization and logistic regression.

Results: This study found little evidence of differences between NP and PCP claims in case mix or quality of care.

Conclusions: The process of care indicators that we identified were highly associated with the duration of work disability and have potential for further development to assess and promote quality improvement.

From the Departments of Health Services (Drs Sears, Wickizer, Cheadle), and Environmental and Occupational Health Sciences (Dr Franklin), School of Public Health and Community Medicine, University of Washington, Seattle, Washington; and Department of Psychosocial and Community Health (Dr Berkowitz), School of Nursing, University of Washington, Seattle, Washington.

Address correspondence to: Jeanne M. Sears, PhD, MS, RN, Department of Health Services, University of Washington, Box 357660, Seattle, WA 98195; E-mail:

©2007The American College of Occupational and Environmental Medicine