Effects of integration of advanced practice providers into surgical group practice

项目摘要 老年患者在大手术后特别容易发生并发症， 接近35%这种并发症威胁到独立性，并带来更高的死亡风险， 强调在这一人群中仔细协调护理的重要性。与正在进行的 由于多个学科的外科医生短缺，一些外科实践已经纳入 执业护士（NPs）和医生助理（PA），他们提供灵活性， 在住院病人和门诊病人中发挥作用。这种方法的一个优点 包括改进的手术室入口（例如，通过允许外科医生 程序更有效）和诊所（例如，通过卸载选定的患者访问）。此外，本发明还 这种交付模式可以加强指标住院期间的护理协调， 住院和门诊设置，这可能会改善手术结果。潜在 这种模式的缺点与国家警察和公共行政人员在以下方面相对缺乏经验有关： 术后护理，这可能导致延迟并发症的识别，以及 增加的资源使用（例如，通过更多地使用诊断测试和/或咨询 医生）。该项目利用国家医疗保险数据全面评估这些问题 并有以下目标：1）衡量将NP和PA整合到单一的 专科手术实践对医疗保险患者获得护理的影响; 2）确定影响 将NP和PA整合到单一专业手术实践中的手术结果;以及， 3)评估NP和PA整合对不成比例地照顾 脆弱的病人。这项研究的结果将阐明NP和PA如何能够 用于改善医疗保险患者的手术途径和结果， 尤其是弱势群体。此外，该项目将直接向决策者提供信息， 卫生系统领导人，专业协会和外科医生对NP/PA的影响 扩大老年人的外科护理。

Project Summary Elderly patients are particularly susceptible to complications after major surgery, with rates approaching 35%. Such complications threaten independence and carry a higher risk of death, underscoring the importance of careful coordination of care in this population. With ongoing shortages of surgeons across multiple disciplines, some surgical practices have incorporated nurse practitioners (NPs) and physician assistants (PAs) who provide the flexibility of functioning in both the inpatient and outpatient settings. One advantage of this approach includes improved access to the operating room (e.g., by allowing surgeons to perform procedures more efficiently) and clinic (e.g., by offloading selected patient visits). Additionally, this delivery model can enhance care coordination during the index hospitalization, and between the inpatient and outpatient settings, which may improve surgical outcomes. Potential disadvantages of this model relate to the relative inexperience of NPs and PAs with respect to postoperative care, which may result in delayed complication recognition, and the possibility of increased resource use (e.g., through greater use of diagnostic testing and/or consulting physicians). This project comprehensively assesses these issues using national Medicare data and has the following aims: 1) Measure the impact of integration of NPs and PAs into single- specialty surgical practice on access to care for patients with Medicare; 2) Determine the impact of integration of NPs and PAs into single-specialty surgical practice on surgical outcomes; and, 3) Assess the impact of NP and PA integration on practices that disproportionately care for vulnerable Medicare patients. Findings from this study will shed light on how NPs and PAs can be utilized to improve surgical access and outcomes in Medicare patients, and certain vulnerable populations in particular. Furthermore, the project will directly inform policymakers, health system leaders, professional societies and surgeons about the effects of NP/PA expansion on surgical care in the elderly.