The Role of Nurse Practitioners in Improving Access to Primary Care

项目摘要/摘要：本提案响应了AHRQ的特别强调通知(NOT-HS-16-011) 突出了他们对接收与创新初级保健研究有关的申请的持续兴趣。 获得高质量初级保健的机会不平等是造成非卧床护理差距的一个因素-- 敏感的健康状况。随着初级保健的迅速变化，包括执业护士(NPs)，有限 有证据表明，NPS是一种改善初级保健机会的潜在机制。与.相比 医生，NP更有可能治疗有色人种患者、医疗补助覆盖的患者和未参保的患者。 这项拟议的研究将提供第一个量化小学入学机会变化的经验证据 团体实践实施后的护理-特别是针对历史上面临准入挑战的患者群体 一个NP。为此，我们建议使用所有付款人索赔和电子健康记录数据的数据库，以及 全国范围内的初级保健临床医生样本。此数据集允许我们克服以下三个数据挑战 阻碍了对这一主题的研究。首先，我们准确地观察到谁提供了医疗保健服务--哪些 通常与谁为护理买单是不同的。其次，我们观察调度数据，使我们能够构建 客观措施，如就诊等待时间和就诊份额提供给新患者。第三和 最后，我们在我们的样本中观察临床医生提供的所有护理，而不考虑付款人的状态-允许我们 比较患者群体的可及性指标(即，医疗补助患者的可及性与 商业保险患者)。Neprash博士(PI)可以访问并与 建议的数据来源，包括侧重于初级保健的工作。 在目标1中，我们将量化新患者在加入初级保健后获得护理的机会的变化 练习一下。结果包括向新患者提供的就诊份额(即，那些以前没有在 实践)，特别关注新的医疗补助或未参保的患者以及自认为是 黑人、土著和有色人种。 在目标2中，我们将量化在获得和方便护理方面的总体变化，在NP加入 练习一下。结果包括访问等待时间(即访问安排和访问发生之间经过的天数)， 以无预约方式提供的探访所占比例，以及晚上和周末提供的探访所占比例。 这项试点研究将提供关于如何获得护理--特别是AHRQ优先事项--的第一个证据 人口--初级保健服务雇用执业护士时的变化。随着NPs越来越多地 在初级保健实践中普遍存在，了解它们在潜在扩展中所起的作用是至关重要的 获得初级保健服务，并提供高质量、高效率的保健。这一小笔拨款提案代表了 更广泛的研究议程的第一步是了解NPs在减少健康方面所起的作用 差距。

Project Summary/Abstract: This proposal responds to AHRQ’s Special Emphasis Notice (NOT-HS-16-011) highlighting their ongoing interest in receiving applications related to innovative primary care research. Inequitable access to high-quality primary care is one factor contributing to disparities in ambulatory care- sensitive health conditions. As primary care changes rapidly to include nurse practitioners (NPs), limited evidence suggests NPs as a potential mechanism for improving access to primary care. Compared to physicians, NPs are more likely to treat patients of color, patients covered by Medicaid, and uninsured patients. This proposed research will provide the first empirical evidence quantifying changes in access to primary care – particularly for patient populations historically facing access challenges – after group practices employ an NP. To do so, we propose using a database of all-payer claims and electronic health record data with a nationwide sample of primary care clinicians. This dataset allows us to overcome three data challenges that have hindered research on this topic. First, we accurately observe who provided health care services – which is frequently distinct from who billed for the care. Second, we observe scheduling data, allowing us to construct objective measures of access such as visit wait time and share of visits provided to new patients. Third and finally, we observe all care provided by clinicians within our sample, regardless of payer status – allowing us to compare measures of access across patient populations (i.e., access for Medicaid patients compared to commercially-insured patients). Dr. Neprash (PI) has access to and has published extensively with the proposed data source, including work focused on primary care NPs. In Aim 1, we will quantify changes in access to care for new patients, after an NP joins a primary care practice. Outcomes include the share of visits provided to new patients (i.e., those not previously treated at the practice), with a particular focus on new Medicaid or uninsured patients and new patients self-identifying as Black, Indigenous, and people of color. In Aim 2, we will quantify overall changes in access to and convenience of care, after an NP joins a practice. Outcomes include visit wait time (i.e., days elapsed between visit scheduling and visit occurrence), the share of visits provided on a walk-in basis, and the share of visits provided on evenings and weekends. This pilot study will provide the first evidence on how access to care – particularly for AHRQ priority populations – changes when primary care practices employ a nurse practitioner. As NPs become increasingly prevalent within primary care practices, it is crucial to understand the role they play in potentially expanding access to primary care services and providing high-quality, efficient care. This small grant proposal represents the first step in a broader research agenda of understanding the roles that NPs play in reducing health disparities.