Assessing the Role of Nurse Practitioner in Primary Care of Older Adults

 描述（由申请人提供）：随着初级保健医生（MD）的日益短缺，执业护士（NP）填补了提供初级保健的差距。在我们的前三年的资金，我们发现，老年人接受护理从NPs的数量在1998年和2010年之间增长了15倍，并有很大的差异，在接受初级保健从NPs各州。我们还观察到，国家对NP实践的规定与从NP接受初级保健的患者百分比之间存在很强的关联。使用潜在的可预防的住院作为一个质量指标，比较初级保健提供单独的NPs提供的医疗机构提供的社区居住的糖尿病患者，我们发现，由NPs提供的初级保健至少是由初级保健医生提供的。从这个初始资助期的分析集中在患者接受他们的初级保健完全从NP与完全从MD。现在，我们希望将注意力转向在共享护理模式中由两个学科护理的患者。跨学科团队护理-由NP和MD组成-已被推广为新医疗保健计划成功的关键（例如，责任医疗组织（ACO））和根据《平价医疗法案》（ACA）建立的支付模式。随机临床试验（RCT）表明，跨学科团队护理改善了护理过程和结果，特别是对于那些需要与各种医疗保健提供者进行多次接触的复杂医疗状况的患者。然而，这些模型如何在更多样化的患者群体和临床环境中运行尚不清楚。我们提出的更新研究-第一次全国人口为基础的跨学科团队模型的调查，提供初级保健在现实世界的患者-将解决这一关键的知识差距。我们将重点研究团队初级保健模式，并评估与这种模式相关的因素和结果，在慢性疾病（糖尿病，充血性心力衰竭和慢性阻塞性肺疾病）患者。具体目标是：1.识别和表征不同的团队护理模式，涉及NP和初级保健医生使用社会网络分析; 2。确定与接受NP-MD团队护理模式护理相关的患者、区域和卫生系统因素;以及3.检查NP-MD团队护理模式与仅涉及初级保健医生的传统模式相比提供的护理过程，结果和成本。为了实现这些目标，我们将使用2013年至2016年全国医疗保险受益人样本的索赔来进行这项比较有效性研究。

 DESCRIPTION (provided by applicant): With the increasing shortage of primary care physicians (MDs), nurse practitioners (NPs) have filled the gap in providing primary care. In our first three years of funding, we found that the number of older adults receiving care from NPs grew fifteen-fold between 1998 and 2010, and that there was substantial variation in the receipt of primary care from NPs across states. We also observed a strong association between state regulations of NP practice and the percent of patients receiving their primary care from NPs. Using potentially preventable hospitalization as a quality indicator to compare primary care delivered solely by NPs to care delivered by MDs in community dwelling patients with diabetes, we found that primary care provided by NPs was at least comparable to that provided by primary care physicians. The analyses from this initial funding period have focused on patients receiving their primary care exclusively from NPs vs. exclusively from MDs. We now wish to turn our attention to patients cared for by both disciplines in a shared care model. Interdisciplinary team care- comprised of NPs and MDs- has been promoted as a key to the success of new healthcare programs (e.g., Accountable Care Organizations (ACOs)) and payment models established under the Affordable Care Act (ACA). Randomized clinical trials (RCTs) have shown that the interdisciplinary team care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care for multiple encounters with various health care providers. How these models operate in more diverse patient populations and clinical settings, however, is unknown. Our proposed renewal study-the first national population-based investigation of interdisciplinary team models providing primary care in real-world patients- will address this critical gap in knowledge. We will focus on examining team primary care models and assessing the factors and outcomes associated with such models, in patients with chronic conditions (diabetes, congestive heart failure, and chronic obstructive pulmonary disease). The specific aims are to: 1. Identify and characterize different team care models involving NPs and primary care physicians using social network analysis; 2. Determine patient, regional and health system factors associated with receiving care from NP-MD team care models; and 3. Examine the processes, outcomes and cost of care provided by NP-MD team care models compared with the traditional model involving primary care physicians only. To address these aims, we will use claims from national samples of Medicare beneficiaries from 2013 through 2016 to conduct this comparative effectiveness research.