Effects of advanced practice nurses on health-care costs, quality of care, and patient well-being: A meta-analysis of randomized controlled trials

Abstract

Background

The growing recognition of advanced practice nurses' role has been challenged by the need for decreased health-care costs while ensuring quality of care and patient well-being. However, limited evidence exists from previous reviews evaluating the effectiveness of advanced practice nurses.

Objectives

To investigate the effects of advanced practice nurses on health-care costs, quality of care, and patient well-being.

Design

A meta-analysis of randomized controlled trials.

Methods

A literature search was conducted in CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, and Web of Science from their inception to June 2023. The primary outcome was health-care costs, including total cost with direct (hospitalization, medication, and diagnostic costs) and indirect costs. The secondary outcomes were quality of care (hospitalization, readmission, length of stay, mortality and patient satisfaction) and well-being [mental (anxiety, depression), physical (pain, fatigue), and quality of life]. Hedges' g and odds ratio with corresponding 95 % confidence intervals were calculated using a random-effects model to obtain pooled effect estimates for the primary and secondary outcomes. Heterogeneity was determined using I² and Q statistics, and moderator analysis was performed to determine the sources of heterogeneity. Publication bias was evaluated using the Begg and Mazumdar rank correlation and Egger's test and through the visual inspection of a funnel plot.

Results

In this review, we included 22 studies involving 7764 participants, mostly women (56.4 %). Compared with other health professionals, advanced practice nurses significantly reduced patients' total costs (g, − 0.21; 95 % confidence interval, − 0.30 to − 0.12), lowered direct costs (g, − 0.15; 95 % confidence interval, − 0.22 to − 0.08), and decreased hospitalization costs (g, − 0.19; 95 % confidence interval, − 0.34 to − 0.04). As well, advanced practice nurses significantly lowered hospital readmissions (odds ratio, 0.25; 95 % confidence interval, 0.11 to 0.57), increased patient satisfaction (g, 0.54; 95 % confidence interval, 0.31 to 0.77), reduced anxiety (g, − 0.36; 95 % confidence interval, − 0.71 to − 0.00), depression (g, − 0.28, 95 % confidence interval, − 0.46 to − 0.10), pain (g, − 0.20; 95 % confidence interval, − 0.35 to − 0.04), and fatigue (g, − 0.24; 95 % confidence interval, − 0.41 to − 0.07). Patient satisfaction improved in disease management, follow-up care, and blended intervention, although did not reach statistical significance.

Conclusion

Integrating advanced practice nurses into health-care settings contributes to reducing health-care cost, improving quality of care, and enhancing patient well-being. This meta-analysis provides evidence supporting advanced practice nurses, reinforcing their vital role in the health-care system and highlighting the need for initiatives and advocacy to enhance their scope of practice and promote advanced education.

Registration

PROSPERO (CRD42023449803).

Tweetable abstract

This meta-analysis revealed that advanced practice nurses reduce health-care costs, improve quality of care, and enhance patient well-being. @4_INAns