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）的短缺将日益严重。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，从NP接受门诊治疗的老年患者的百分比迅速增长，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获得大部分初级保健。NP护理率因地理位置而异。在10个医院转诊区域（HRR）中，超过10%的老年人从NPs获得大部分初级保健，而在70个HRR中，不到1%的老年人从NPs获得大部分护理。NP实践对国家法规非常敏感。与监管最严格的州相比，监管最自由的州的受益人从非营利组织获得大部分初级保健的几率高出三倍。在比较NP与医生提供的护理的五项RCT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，美国的研究来自一个学术健康中心。目前还没有国家或人口为基础的研究评估NP护理的过程，结果和成本。我们的具体目标是：1。比较NP和全科医生提供的护理过程和质量，重点是初级和二级预防过程，以及访问的强度和频率，潜在的不适当使用药物，坚持使用关键药物，以及接受专家咨询。2.比较护理的结果之间提供的护理NP和全科医生，重点是住院的门诊护理敏感的条件。3.比较由NP和全科医生提供的医疗保险费用。为了实现这些目标，我们将使用从2006年到2011年的国家医疗保险受益人样本的索赔进行这项比较有效性研究。

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.