Having an EHR is statistically related to lower non-emergent ED rates, but the years of EHR experience is associated with increased non-emergent ED rates. Accessed March 2014. Manning BT, Bohl DD, Redondo ML, Gerlinger TL, Sporer SM, Paprosky WG, Levine BR. Nurse practitioners (NPs) are essential advocates for health care policy. Health Serv Res. Address correspondence to: John Kralewski, PhD, MHA, Professor Emeritus and Senior Research Fellow, Division of Health Policy and Management, School of Public Health, The University of Minnesota. For example, it is possible that practices with more costly patients, even after standard risk adjustment, hire more NPs. Clipboard, Search History, and several other advanced features are temporarily unavailable. 9. Our data indicate that Medicare costs for primary care medical group practices are associated with the ratio of NPs to NPs plus physicians, but this relationship is nonlinear. 5. Cooper RA. 2003;1(2):97-104. Gysin S, Meier R, van Vught A, Merlo C, Gemperli A, Essig S. BMC Fam Pract. Citation: Puskar, K. R. (June 15, 1996). These include a) mammography rates: mammography rates compared with clinical guidelines for breast cancer screening; b) cardiovascular disease/low-density lipoprotein (CVD/LDL) rates: LDL test rates for patients with CVD; and c) glycated hemoglobin (A1C) rates: glycated hemoglobin test rates for patients with diabetes. The article also discusses political forces at midcentury and the creation of the nurse practitioner role with the premise that nurses can learn from these early initiatives to create new models for nurses’ roles in primary care today. Source of Funding: Funding provided by the Robert Wood Johnson Health Care Financing and Organization initiative. Reinhardt U. While numerous studies have focused on the potential contributions of and need for more NPs,4-7 the factors influencing their roles,8-11 and the quality of their care,12-15 few have examined their association with costs; and to our knowledge, none have assessed their association with practice-level costs or the relationships between those costs and quality of care. Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. 2019 Nov 27;20(1):163. doi: 10.1186/s12875-019-1055-z. The data set for this analysis was created by identifying the adult primary care medical group practices that provided organizational and performance data for the Medical Group Management Association (MGMA) 2009 survey. Since other practice-level attributes have been shown to be associated with cost and quality variables in our previous research, we include 5 of those as control variables in this analysis.20 Those variables, taken from the MGMA survey, are specified as follows: a) practice ownership: physician-owned, hospital-owned, other-owned (eg, community health centers, health insurance plans, local government agencies); b) net revenue: net revenue after operating costs as a percentage of total net revenue; c) rural versus urban location: rural if in a community of 5000 or fewer population; d) EHR: practice has an EHR; and e) years with EHR: number of years since implementing EHR. Jennings N, O’Reilly G, Lee G, Cameron P, Free B, Bailey M. Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia. The descriptive statistics are shown separately for practices employing no NPs versus some NPs. COVID-19 is an emerging, rapidly evolving situation. With regard to the presence of nurse practitioners in nonrural settings, there was an increase from 15.9% in 2008 to 23% in 2016. The NP staffing ratio is unrelated to practice net revenue despite the (nonlinear) relationship of NPs to Medicare costs and the obvious reduction in patient-care costs to the practice if NPs are substituted for physician labor. Lower staffing has no effect on costs or quality, but employing two NPs per physician reduces costs and improves quality. This site needs JavaScript to work properly. The advanced nurse practitioner is but one model and is sometimes described as a hybrid role because, although it holds true to the underpinning philosophy of nursing practice, it also encompasses a skillset traditionally considered to be that of doctors. The author has disclosed no financial relationships related to this article. A production function for physician services. 3. 8. Both ratios are below the cost-maximizing ratio. Cochrane Database Syst Rev. Both are statistically significant at close to the 0.05 level. BMJ. The Health Resources and Services Administration identified more than 5000 primary care shortage areas as of January 2013. Health Serv Res. Shortage designation: health professional shortage areas & medically underserved areas/populations. In contrast, the mean ratio across the entire sample (including practices that employ no NPs) is 0.154, or about 1 NP per 6.5 physicians. doi: 10.1111/j.1365-2702.2007.02038.x. The practices are located in 26 states, and although this is not a nationally representative sample of primary care medical group practices, it covers many different regions of the United States and provides a relatively large and diverse convenience sample to support our analysis. Those results imply that among practices with some NPs, risk-adjusted PBPY costs are higher up to 0.32 and decline thereafter as the ratio increases. This is an important measure of the relationship between practice-level revenue and cost of care, and a measure of the contribution of NPs to the efficiency of the medical group practice in providing services. J Am Acad Nurse Pract. The cost-maximizing ratio is 0.32, or about 1 NP for every 2 physicians. Several recent studies have highlighted the pending shortage of primary care physicians (PCPs). Health Aff (Millwood). British Heritage Travel: Florence Nightingale. Sacha Ferguson, Sacha Ferguson ... An alternative approach is to maximize utilization of non-physician providers, including nurse practitioners (NPs) and other advanced practice nurses (APNs), physician assistants and midwives in primary care delivery. Family nurse practitioners (FNP) earn high salaries working in a variety of settings. Costs are calculated from Medicare claims files and are risk-adjusted using the Medicare Hierarchical Condition Category algorithm plus patient age and gender. Role of Nurse Practitioners in Caring for Patients With Complex Health Needs. Multivariate regression results begin in . APPs include APNs as well as physician assistants (PAs). Physician-owned practices have higher A1C testing rates, as do practices with an EHR. Mundinger MO, Kane RL, Lenz ER, et al. In this staffing range, this suggests that the clinical role of NPs has an adverse influence on performance. Electronic databases were searched using the terms role transition and nurse practitioner. Methods: A national sample of primary care medical group practices based on responses to the 2009 Medical Group Management Association Performance Survey. Measures of inappropriate utilization. Agency for Healthcare Research and Quality website. As in most organizational-level studies, organizational characteristics are not assigned randomly to organizations, but are “endogenously” chosen by the organization. Roles of a Nurse Practitioner Working directly with patients, NPs can diagnose and manage most common and many chronic illnesses. There were 5 quality of care measures. Consequently, it is difficult to interpret these results. Health Aff (Millwood). J Healthc Manag. Nurs Res. The employment of more nurse practitioners (NPs) is one of the most promising ways to expand the capacity of medical group practices to meet the projected needs for primary healthcare created by an aging population and increased health insurance coverage under the Affordable Care Act. The cost variable was annual risk-adjusted Medicare expenditures per capita for patients attributed to a practice. BMC Fam Pract. Poghosyan L, Lucero R, Rauch L, Berkowitz B. Nurs Econ. Health Aff (Millwood). The NP variable is entered into our analyses as the ratio of FTE NPs to FTE physicians and NPs in each practice. Their services include, but are not limited to: ordering, conducting and interpreting diagnostic and laboratory tests; prescribing pharmacologic agents and non-pharmacologic therapies; and teaching and counseling. We reviewed the current and projected nurse practitioner … 2018 National NP Sample Survey Results Released. The role of nurse practitioners in reinventing primary care. Rural practices might benefit from lower overhead costs and support staff ratios. Use of midlevel practitioners to achieve labor cost savings in the primary care practice of an MCO. However, little is known about the optimal use of these clinicians in primary care medical practices or the effect of NPs on the costs and quality of care. Keywords nurse practitioner, history, ... Google Scholar | Medline. Practices in the other ownership category (owned by a community health center, the government, or a health plan) have higher A1C and mammography rates. Objectives: The employment of more nurse practitioners (NPs) is one of the most promising ways to expand the capacity of medical group practices. Health Aff (Millwood). This is the focus of our study. The potential of nurse practitioners is not being fully realized in primary care medical practices. Study Design: Eighty-five primary care medical group practices were matched with 315,000 Medicare patients. The role of nurse practitioners in reinventing primary care. Our inability to give a causal interpretation to our coefficients makes them less useful for practices or policy makers who are attempting to change practice outcomes by changing the level of NP staffing. The NP staffing ratio does not appear to be related to non-emergent ED use ratios, but higher ratios are associated with higher ACS admissions (). As we consider the challenges of practicing as advanced practice nurses in the 21st century, it is instructive to look back on 100 years of creating new programs and systems for delivering care. : How to collaborate effectively with psychiatric nurse practitioners. Nurs Econ. 21. AUSTIN, TEXAS (January 28, 2019) – The American Association of Nurse Practitioners ® (AANP) released both the new national nurse practitioner (NP) count and findings from its 2018 National Nurse Practitioner Sample Survey. “Ambulatory care sensitive” conditions. new forecasts and implications for healthcare delivery. 2004;291(10):1246-1251. 18. Rural practices have lower CVD/LDL rates but do not differ on the other measures. The Nurse Practitioner: June 11, 2018 - Volume 43 - Issue 6 - p 8 doi: 10.1097/01.NPR.0000532769.99003.ba Hooker RS, McCaig LF. NP staffing ratios are not statistically related to performance on any of these measures. They have the clinical expertise and the educational background to present the case for passing legislation on health care issues. As of January, a record of more than 270,000 nurse practitioners (estimated) are licensed to practice in … Review of Economics and Statistics. 4. Nurs Inq. More research is needed to explore potential confounders and the causal pathways that link the use of NPs to cost and quality of care. Nurse Practitioners: The first nurse practitioner training program was conceived in 1965 at the University of Colorado Tools for monitoring the health care safety net [AHRQ publication No. We cannot say that medical practices will experience the outcomes indicated by our estimated coefficients if they alter the number of NPs they employ. NYU Wagner website. Findings and Conclusions. 2020 Jul 24:S0197-4572(20)30206-8. doi: 10.1016/j.gerinurse.2020.07.001. We also include a net revenue after operating costs variable in our analysis to determine the association of NPs with the profit level of the practice. Nurse practitioner workforce: a substantial supply of primary care providers. Online Journal of Issues in Nursing.Vol. evidence from nurse practitioners and physician assistants. Dropping them had little effect on the NP coefficients. McGivern, D. (1986). The theoretical model proposed by Liu and D’Aunno (2012)21 suggests that these performance differences may result from differences in the clinical roles of NPs at various staffing levels. Advanced practice nurse outcomes 1990-2008: a systematic review. Consequently, cost and quality gains are not being achieved. Acad Med. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/V… Results: Employing NPs in primary care practices is associated with increased risk-adjusted patient cost for up to 1 NP for every 2 physicians, but cost decreases as the number of NPs per physician increases. 10. Per beneficiary per year total costs and quality of care were calculated from Medicare claims data. We recommend that nurse practice acts--the state laws governing how nurses may practice--be standardized, that equivalent reimbursement be paid for comparable services regardless of practitioner, and that performance results be publicly reported to maximize the high-quality care that nurse practitioners provide. http://wagner.nyu.edu/faculty/billings/acs-algorithm.php. The outcomes of nurse practitioner (NP)-Provided home visits: A systematic review. The purpose of this study was to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours. The evolution of advanced practice nurses to care for women and newborns has its roots in public health nursing of the latter decades of the 19th century. Ann Fam Med. Nurse practitioner (NP), nonphysician clinician who is a nurse with a graduate degree in advanced-practice nursing. Nurse practitioners as an underutilized resource for health reform: evidence-based demonstrations of cost-effectiveness. 15. 2010;29(5):893-899. Hospitals & Health Networks: The Changing Role of Nurses. NLM For example, on the research site PubMed, in the decade 1982-1991 there were only seven articles addressing ‘spirituality & nursing,’ and three ‘religious & nursing’. If higher NP staffing levels are related to the development of team-based patient care, this could account for an association with decreased patient-level costs, although it does not appear that quality of care is improved, nor does it result in improved net revenue in the practices. Findings. 2008 Jun;15(2):116-26. doi: 10.1111/j.1440-1800.2008.00404.x. All of these analyses used ordinary least squares regression equations to estimate the association of the explanatory variables, including the NP/physician staffing ratios with patient-level cost and quality and practice-level economic efficiency. Nurse practitioner staffing data indicate that employing 0.25 to 0.50 NPs per primary care physician increases patient-level costs and decreases quality. These may include family nurse practitioners or adult gerontology nurse practitioners, for example. Online ahead of print. http://www.hrsa.gov/shortage/. An extensive recent review of the contributions of advanced practice nurses to primary care conducted by Laurant et al (2014)16 identified over 1100 publications, but only 3 studies assessed resource utilization such as consultation rates and prescription drug use, and 2 addressed direct costs, including labor costs per patient visit. The Role of Nursing in Spiritual Care: Within the nursing literature, interest in spirituality has increased exponentially in the last several decades. 2011;89(1):69-89.  |  © 2020 MJH Life Sciences and AJMC. Brown SA, Grimes DE. 23. All rights reserved. http://archive.ahrq.gov/data/safetynet/tools.htm. 2013 Nurse practitioner state practice environment. Accessed March 2014. 16. Auerbach DI. Substitution of doctors by nurses in primary care. Roblin DW, Howard DH, Becker ER, Adams EK, Roberts MH. 6. NPs diagnose and manage acute and chronic conditions and emphasize health promotion and disease prevention. A meta-analysis of nurse practitioners and nurse midwives in primary care. Author Disclosures: The authors do not have any conflict of interest relationships related to this research, and the corresponding author attests that all individuals who contributed to the manuscript have been appropriately acknowledged. Stange K. How does provider supply and regulation influence health care markets? Medical administrators should evaluate the influence of NP staffing ratios on their clinical roles and subsequent cost and quality performance. Perhaps there are unobserved variables that influence decisions to hire NPs and also influence patient-level cost and quality. 2020 Aug 13;21(1):164. doi: 10.1186/s12875-020-01240-8. RCNI: Patient Advocacy: The Role of the Nurse. Nutting PA, Crabtree BF, McDaniel RR. Psychiatric mental health nurse practitioners (PMHNPs) are assuming increasing clinical responsibilities in the treatment of individuals with mental illness as the shortage of psychiatrists and their maldistribution continues to persist in the United States. 2008;17(8):1044–50. 15. This annual award was established in 2019 in recognition of … Practices employing NPs have higher rates of non-emergent ED visits and lower rates of CVD/LDL testing than practices not employing NPs. However, our findings alert medical group practice administrators and physicians to the need to pay more attention to the roles of nurse practitioners when adding them to their clinical teams. 2005;(2):CD001271. 6 Drawing on a convenience sample of 352 NP participants at a national conference, she administered a 16-item Nurse Practitioner Role Transition Scale. Differences in payment rates are adjusted using the Medicare Geographic Practice Cost Index. The evolving role of nurse practitioners (NPs) as primary care providers, especially for vulnerable populations, is central to the debate regarding strategies to address the growing need for primary care services. JNP: The Journal for Nurse Practitioners offers high-quality, peer-reviewed clinical articles, original research, continuing education, and departments that help practitioners excel as providers of primary and acute care across the lifespan.

role of nurse practitioner scholarly articles

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role of nurse practitioner scholarly articles 2020