Assessing The Role of Nurse Practitioner in Primary Care of Older Adults

描述（由申请人提供）：随着美国人口的增长和老龄化，预计初级保健提供者（PCP）的短缺日益增加。解决短缺的一种方法是增加执业护士（NP）作为pcp的作用。我们的初步数据表明，接受国家养老机构门诊治疗的老年患者比例迅速增长，从1997年的0.4%增长到2008年的8.4%。到2008年，2.5%的医疗保险受益人从NP那里获得了大部分的初级保健。NP护理率因地理位置的不同而有很大差异。在10个医院转诊区，超过10%的老年人从医院转诊区获得大部分初级护理，而在70个医院转诊区，只有不到1%的老年人从医院转诊区获得大部分护理。NP实务对国家法规相当敏感。与监管最严格的州相比，在监管最宽松的州，受益人从np那里获得大部分初级保健的几率是其他州的三倍。比较NPs和医生提供的护理的五项随机对照试验中，有四项是在美国以外的不同医疗保健系统中进行的，美国的研究来自一家学术卫生中心。目前还没有全国性或以人群为基础的研究评估NP护理的过程、结果和成本。我们的具体目标是：1；比较NPs和全科医生提供的护理流程和质量，重点关注初级和二级预防流程、就诊强度和频率、潜在的不当用药、对关键药物的依从性以及接受专家咨询。2. 比较NPs和全科医生提供的护理结果，重点关注门诊敏感条件的住院治疗。3. 比较NPs和全科医生提供的医疗费用。为了实现这些目标，我们将使用2006年至2011年全国医疗保险受益人样本的索赔来进行比较有效性研究。

DESCRIPTION (provided by applicant): An increasing shortage of primary care providers (PCP) is projected as the US population grows and ages. One approach to address the shortage is to increase the role of nurse practitioners (NP) as PCPs. Our preliminary data suggest a rapid growth in the percent of older patients who received outpatient care from NPs, from 0.4% in 1997 to 8.4% in 2008. By 2008, 2.5% of Medicare beneficiaries received the majority of their primary care from an NP. The rate of NP care varies substantially by geographic location. In 10 Hospital Referral Regions (HRRs), more than 10% of the elderly received the majority of their primary care from NPs, while less than 1% of the elderly received the majority of their care from NPs in 70 HRRs. NP practice is quite sensitive to state regulations. Compared with states with the most restrictive regulations, the odds of receiving the majority of primary care from NPs was three fold higher for beneficiaries in states with the most liberal regulations. Four of the five RCTs comparing care provided by NPs vs. physicians were conducted outside the US in different health care delivery systems, and the US study was from an academic health center. No national or population-based studies have yet assessed the processes, outcomes and costs of NP care. Our Specific Aims are: 1. Compare process and quality of care provided by NPs and generalist physicians, with a focus on processes of primary and secondary prevention, and intensity and frequency of visits, potential inappropriate use of medication, adherence to key medications, and receipt of specialist consultations. 2. Compare outcomes of care between care provided by NPs and generalist physicians, focusing on hospitalizations for ambulatory care sensitive conditions. 3. Compare Medicare costs between care provided by NPs and generalist physicians. To address these aims, we will use claims from national samples of Medicare beneficiaries from 2006 through 2011 to conduct this comparative effectiveness research. PUBLIC HEALTH RELEVANCE: An increasing shortage of primary care providers is projected as the US population grows and ages. One approach to address the shortage is to increase the role of nurse practitioners in primary care. We will use Medicare and other data to assess the processes, outcomes, and costs for care provided by nurse practitioners, generalist physicians, or both in general practice.