Greenfield, SheldonKomaroff, AnthonyPass, Theodore M.Anderson, HjalmarNessim, Sharon2021-03-171978-02-09Greenfield, S, A.L. Komaroff, T.M. Pass, H. Anderson, and S. Nessim. 1978. "Efficiency and Cost of Primary Care by Nurses and Physician Assistants." New England Journal of Medicine.; 298(6):305-9. PMID: 23495.0028-47931533-4406https://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37367070We conducted a prospective study in a prepaid primary-care practice (health-maintenance organization) of a system in which nurses and physician assistants used protocols, and compared the efficiency and costs of this "new-health-practitioner" protocol system to a physician-only nonprotocol system. In five months, we studied 472 patients with any of four common acute complaints — respiratory infections, urinary and vaginal infections, headache, and abdominal pain; a subset of 203 patients was randomly allocated between the two systems. In the new-health-practitioner system physician time per patient was reduced by 92 per cent, from 11.8 to 0.9 minutes, and average visit costs — including practitioner time and charges for laboratory tests and medications — were 20 per cent less (P = 0.01). We conclude that this protocol system saves physician time and reduces costs. (N Engl J Med 298:305–309, 1978)en-USGeneral MedicineJournal Article2021-03-1710.1056/nejm197802092980604