Effects of integration of advanced practice providers into surgical group practice

项目摘要 老年患者尤其容易发生大手术后的并发症， 接近35%。这种并发症威胁到独立，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。正在进行中 跨多个学科的外科医生短缺，一些外科实践已纳入 护士从业人员(NP)和医生助理(PA)，他们提供以下灵活性 在住院和门诊环境中都能发挥作用。这种方法的一个优点是 包括更方便地进入手术室(例如，通过允许外科医生执行 更有效的程序)和诊所(例如，通过分流选定的病人就诊)。另外， 这种交付模式可以加强指数住院期间和之间的护理协调 住院和门诊设置，这可能会改善手术结果。潜力 这一模式的缺点在于非政府组织和非政府组织在以下方面相对缺乏经验 术后护理，这可能导致延迟的并发症识别，以及 增加资源使用(例如，通过更多地使用诊断测试和/或咨询 医生)。该项目使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NPS和PAS整合为单一- 关于医疗保险患者获得护理的专业外科实践；2)确定影响 将NPS和PAS整合到单一专科外科实践中对手术结果的影响；以及 3)评估NP和PA整合对过度关注的实践的影响 脆弱的医疗保险患者。这项研究的发现将阐明NP和PA如何 用于改善医疗保险患者的手术机会和结果，以及某些 尤其是弱势群体。此外，该项目将直接告知政策制定者， 卫生系统领导人、专业协会和外科医生讨论NP/PA的影响 扩大对老年人的外科护理。

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.