The Role of Nurse Practitioners in Improving Access to Primary Care

项目概要/摘要：本提案响应AHRQ的特别强调通知（NOT-HS-16-011） 强调他们对接受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门诊护理不平等的一个因素， 敏感的健康状况。由于初级保健迅速变化，包括执业护士（NP），有限 有证据表明，国家方案是改善获得初级保健的一种潜在机制。相比 医生，NPs更有可能治疗有色人种患者，医疗补助覆盖的患者和无保险的患者。 这项拟议中的研究将提供第一个实证证据，量化获得初级教育的变化， 护理-特别是对于历史上面临访问挑战的患者群体-在小组实践采用 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， 全国范围内的初级保健临床医生样本。这个数据集使我们能够克服三个数据挑战， 阻碍了对这一课题的研究。首先，我们准确地观察谁提供了医疗保健服务-- 通常与为护理付费的人不同。其次，我们观察调度数据，使我们能够构建 客观衡量获得服务的机会，如就诊等待时间和向新病人提供就诊的比例。三和 最后，我们观察了样本中临床医生提供的所有护理，无论付款人身份如何，这使我们能够 比较患者群体之间的访问度量（即，与医疗补助患者相比， 商业保险患者）。Neprash博士（PI）可以访问并广泛发表 建议的数据来源，包括重点关注初级保健NP的工作。 在目标1中，我们将量化NP加入初级保健后新患者获得护理的变化 实践结果包括为新患者提供的就诊份额（即，那些以前没有接受过治疗的人 实践），特别关注新的医疗补助或无保险的患者和新患者自我识别为 黑人，土著人和有色人种。 在目标2中，我们将量化一个NP加入一个NP后， 实践结果包括访问等待时间（即，访视安排和访视发生之间的天数）， 无预约探访的比例以及晚上和周末探访的比例。 这项试点研究将提供第一个证据，说明如何获得护理-特别是AHRQ的优先事项 人口-初级保健做法雇用执业护士时的变化。随着NPs越来越多 在初级保健实践中普遍存在，关键是要了解他们在潜在的扩大 获得初级保健服务和提供高质量、高效率的护理。这一小笔赠款提案代表了 这是更广泛的研究议程的第一步，即了解纳米颗粒在减少健康方面的作用， 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.