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，初级保健提供者(PCP)的短缺预计会越来越多。解决短缺的一种方法是增加护士从业者(NP)作为初级保健医生的作用。我们的初步数据显示，接受非政府组织门诊治疗的老年患者的比例迅速增长，从1997年的0.4%上升到2008年的8.4%。到2008年，2.5%的医疗保险受益人从国家医疗机构获得了大部分初级保健服务。NP护理比率因地理位置不同而有很大差异。在10个医院转诊区域中，超过10%的老年人从非营利机构获得了大部分初级护理，而在70个医院转诊区域中，不到1%的老年人获得了来自非营利机构的大部分护理。NP实践对国家规定相当敏感。与监管最严格的州相比，监管最宽松的州的受益人从NPS获得大部分初级保健的几率高出三倍。在比较NPS和医生提供的医疗服务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提供系统中进行的，而美国的这项研究来自一家学术健康中心。目前还没有全国性或基于人群的研究评估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过程和质量，重点是一级和二级预防的过程，以及就诊的强度和频率、潜在的不当用药、对关键药物的坚持以及接受专家会诊。2.比较非营利组织和全科医生提供的护理结果，重点是门诊敏感情况下的住院治疗。3.比较由NP提供的医疗保健和全科医生提供的医疗保险成本。为了实现这些目标，我们将使用2006年至2011年医疗保险受益人的全国样本中的索赔来进行这项比较有效性研究。 与公共卫生相关：随着美国人口的增长和老龄化，初级保健提供者的短缺预计会越来越多。解决短缺的一种方法是增加护士从业人员在初级保健中的作用。我们将使用联邦医疗保险和其他数据来评估由执业护士、全科医生或全科医生提供的护理过程、结果和成本。

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.