Brian Rice1, Usha Periyanayagam2, Stacey Chamberlain3, Bradley Dreifuss4, Heather Hammerstedt5, Sara Nelson6, Samuel Maling7, Mark Bisanzo8. 1. Department of Emergency Medicine, New York University School of Medicine, New York, New York; brian.rice@nyumc.org. 2. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; 3. Department of Emergency Medicine, University of Illinois-Chicago, Chicago, Illinois; 4. Department of Emergency Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona; 5. Department of Emergency Medicine, Idaho Emergency Physicians, Boise, Idaho; 6. Department of Emergency Medicine, Maine Medical Center, Portland, Maine; 7. Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda; and. 8. Department of Emergency Medicine, University of Massachusetts, Worchester, Massachusetts.
Abstract
BACKGROUND: A nonphysician clinician (NPC) training program was started in Uganda in 2009. NPC care was initially supervised by a physician and subsequent care was independent. The mortality of children under 5 (U5) was analyzed to evaluate the impact of transitioning NPC care from physician-supervised to independent care. METHODS: A retrospective review was performed of a quality assurance database including 3-day follow-up for all patients presenting to the emergency department (ED). Mortality rates were calculated and χ(2) tests used for significance of proportions. Multiple logistic regression was used to assess independent predictors of mortality. RESULTS: Overall, 68.8% of 4985 U5 patients were admitted and 28.6% were "severely ill." The overall mortality was significantly lower in physician-supervised versus independent NPC care (2.90% vs 5.04%, P = .05). No significant mortality difference was seen between supervised and unsupervised care (2.17% vs 3.01%, P = .43) for the majority of patients that were not severely ill. Severely ill patients analyzed separately showed a significant mortality difference (4.07% vs 10.3%, P = .01). Logistic regression revealed physician supervision significantly reduced mortality for patients overall (odds ratio = 0.52, P = .03), but not for nonseverely ill patients analyzed separately (odds ratio = 0.73, P = .47). CONCLUSIONS: Though physician supervision reduced mortality for the severely ill subset of patients, physicians are not available full-time in most EDs in Sub-Saharan Africa. Training NPCs in emergency care produced noninferior mortality outcomes for unsupervised NPC care compared with physician-supervised NPC care for the majority of U5 patients.
BACKGROUND: A nonphysician clinician (NPC) training program was started in Uganda in 2009. NPC care was initially supervised by a physician and subsequent care was independent. The mortality of children under 5 (U5) was analyzed to evaluate the impact of transitioning NPC care from physician-supervised to independent care. METHODS: A retrospective review was performed of a quality assurance database including 3-day follow-up for all patients presenting to the emergency department (ED). Mortality rates were calculated and χ(2) tests used for significance of proportions. Multiple logistic regression was used to assess independent predictors of mortality. RESULTS: Overall, 68.8% of 4985 U5 patients were admitted and 28.6% were "severely ill." The overall mortality was significantly lower in physician-supervised versus independent NPC care (2.90% vs 5.04%, P = .05). No significant mortality difference was seen between supervised and unsupervised care (2.17% vs 3.01%, P = .43) for the majority of patients that were not severely ill. Severely ill patients analyzed separately showed a significant mortality difference (4.07% vs 10.3%, P = .01). Logistic regression revealed physician supervision significantly reduced mortality for patients overall (odds ratio = 0.52, P = .03), but not for nonseverely ill patients analyzed separately (odds ratio = 0.73, P = .47). CONCLUSIONS: Though physician supervision reduced mortality for the severely ill subset of patients, physicians are not available full-time in most EDs in Sub-Saharan Africa. Training NPCs in emergency care produced noninferior mortality outcomes for unsupervised NPC care compared with physician-supervised NPC care for the majority of U5 patients.
Authors: Brian Rice; Ashley Pickering; Colleen Laurence; Prisca Mary Kizito; Rebecca Leff; Steven Jonathan Kisingiri; Charles Ndyamwijuka; Serena Nakato; Lema Felix Adriko; Mark Bisanzo Journal: BMJ Open Date: 2022-06-29 Impact factor: 3.006
Authors: Cindy Carol Bitter; Brian Rice; Usha Periyanayagam; Bradley Dreifuss; Heather Hammerstedt; Sara W Nelson; Mark Bisanzo; Samuel Maling; Stacey Chamberlain Journal: BMJ Open Date: 2018-02-24 Impact factor: 2.692
Authors: Brian Rice; Joseph Leanza; Hani Mowafi; Nicholas Thadeus Kamara; Edgar Mugema Mulogo; Mark Bisanzo; Kian Nikam; Hilary Kizza; Jennifer A Newberry; Matthew Strehlow; Michael Kohn Journal: Acad Emerg Med Date: 2020-06-18 Impact factor: 3.451