RB- Delegation PracticesBackground:
  • There is minimal understanding of the individual physician factors that drive greater cost-efficiency of health care without sacrificing quality.
  • Some of this variation may be attributable to variation in utilization of nurses, including nature of task delegation.
  • Survey data was collected from a non-representative sample of internists practicing in Massachusetts, California, Oregon, and Washington who were either in the top-performing decile (n=100) or the 45th and 55th percentile (n=100) on dimensions of cost-efficiency and quality.
  • Physicians were asked whether they delegated each of 24 tasks, grouped into four high-level categories (Electronic Health Record entry, physical exam, health assessment, and treatment), to Nurse Practitioners (NPs), Physician Assistants (PAs), Registered Nurses (RNs), Licensed Practical Nurses (LPNs), or Licensed Vocational Nurses (LVNs),  or Nursing/Medical Assistants.
Key Findings:
  • By role, physicians in the top decile were significantly more likely to delegate one or more tasks to NPs and RNs. (Figure 1)   
  • Physicians in the top decile were significantly more likely to delegate one or more treatment tasks (e.g., provided wound care) to RNs and one or more physical exam tasks (e.g., assessed vital signs) to LVNs/LPNs. (Figure 2)
  • Physicians in the top decile were significantly less likely to delegate one or more health assessment tasks (e.g., obtained health history) to Nursing Assistants/Medical Assistants. (Figure 2)
Author Information: 

Julia Adler-Milstein