A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers
A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers
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DOI：
10.1097/mlr.0000000000000689
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发表时间：
2017-06-01
期刊：
影响因子：
3
通讯作者：
Barnow, Burt S.
中科院分区：
文献类型：
--
作者：
Kurtzman, Ellen T.;Barnow, Burt S.
背景：根据《平价医疗法案》，社区卫生中心（HC）的数量和能力正在增长。虽然大多数HC护理是由初级保健医生（PCMD）提供的，但越来越多的比例是由执业护士（NP）和医生助理（PA）提供的;然而，关于这些临床医生的护理在这种情况下的比较知之甚少。目的：比较HC中NP、PA和PCMD的护理质量和实践模式。使用5年的数据（2006-2010年）从全国门诊医疗调查的HC子样本和多变量回归分析，我们评估了接受NP或PA提供的护理与PCMD提供的护理的影响。我们使用基于设计和基于模型的推理和加权所有estimation.Subjects：主要分析包括23,704例患者访问1139 acquiretionersa样本代表约30万患者访问HC在美国。措施：我们检查了9个患者水平的结果：3个质量指标，4个服务利用措施，和2个转诊模式measures.Results：在7的9个研究结果，没有统计学上的显着差异被检测到NP或PA护理与PCMD护理相比。在其他结果方面，与PCMD相比，NPs更有可能接受推荐的戒烟咨询和更多的健康教育/咨询服务（P0. 05）。访问PA也收到了更多的健康教育/咨询服务比访问PCMDs（P0.01;设计为基础的模型只）。结论：在研究的结果，结果表明，NP和PA的护理在很大程度上相当于PCMD护理在HC。
Background:Under the Affordable Care Act, the number and capacity of community health centers (HCs) is growing. Although the majority of HC care is provided by primary care physicians (PCMDs), a growing proportion is delivered by nurse practitioners (NPs) and physician assistants (PAs); yet, little is known about how these clinicians' care compares in this setting.Objectives:To compare the quality of care and practice patterns of NPs, PAs, and PCMDs in HCs.Research Design:Using 5 years of data (2006-2010) from the HC subsample of the National Ambulatory Medical Care Survey and multivariate regression analysis, we estimated the impact of receiving NP-delivered or PA-delivered care versus PCMD-delivered care. We used design-based and model-based inference and weighted all estimates.Subjects:Primary analyses included 23,704 patient visits to 1139 practitionersa sample representing approximately 30 million patient visits to HCs in the United States.Measures:We examined 9 patient-level outcomes: 3 quality indicators, 4 service utilization measures, and 2 referral pattern measures.Results:On 7 of the 9 outcomes studied, no statistically significant differences were detected in NP or PA care compared with PCMD care. On the remaining outcomes, visits to NPs were more likely to receive recommended smoking cessation counseling and more health education/counseling services than visits to PCMDs (P0.05). Visits to PAs also received more health education/counseling services than visits to PCMDs (P0.01; design-based model only).Conclusions:Across the outcomes studied, results suggest that NP and PA care were largely comparable to PCMD care in HCs.