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Nurse Practitioners as Attending Providers for Injured Workers: Evaluating the Effect of Role Expansion on Disability and Costs

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

doi: 10.1097/MLR.0b013e3181468e8c
Original Article

Background: A 3-year pilot program to expand the role of nurse practitioners (NPs) in the Washington State workers’ compensation system was implemented on July 1, 2004. This legislation authorized NPs to independently perform most functions of an attending physician.

Objective: The purpose of this study was to assess the impact of this legislation by examining medical costs and disability outcomes for injured workers in the care of NPs benchmarked against those in the care of primary care physicians (PCPs).

Research Design: This observational study compared NPs and PCPs in the role of attending provider based on the medical costs and disability outcomes of injured workers in their care. Comparisons controlled for sociodemographics, geographic location, injury, employment, and provider characteristics.

Data Source: The Washington State Department of Labor and Industries provided claim and medical billing data for 29,949 injured workers who had an accident report filed by an NP or PCP between July 1, 2004 and June 30, 2005. Data were collected through June 30, 2006.

Results: NPs were more likely than PCPs to be located in rural areas and counties with high unemployment. The distributions of injury type and severity/complexity indicators were similar across provider types. The likelihood of any time loss was lower for NP claims, but duration of lost work time and medical costs did not significantly differ by provider type.

Conclusions: Attending provider type is not a significant predictor of disability or medical costs for injured workers in Washington State.

From the Departments of *Health Services; †Environmental and Occupational Health Sciences, School of Public Health and Community Medicine; and ‡Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington.

Supported by the NIOSH ERC Occupational Health Services Research Training Program (Nos. T42 CCT010418 and 1 T42 0H008433) and by the University of Washington Occupational Epidemiology and Health Outcomes Program.

Preliminary findings were presented to the Workers Compensation Research Group on November 10, 2006 in Boston, MA.

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

© 2007 Lippincott Williams & Wilkins, Inc.