role of nurse practitioner scholarly articles
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. These may include family nurse practitioners or adult gerontology nurse practitioners, for example. Review of Economics and Statistics. As pointed out by Roblin et al (2004),17 while labor costs per patient visit decline in managed care organizations as more PAs and NPs are employed, more research is needed on delivery system cost savings and cost-effectiveness. 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. American Association of Nurse Practitioners website. The author has disclosed no financial relationships related to this article. For example, it is possible that practices with more costly patients, even after standard risk adjustment, hire more NPs. 2020 Jul 24:S0197-4572(20)30206-8. doi: 10.1016/j.gerinurse.2020.07.001. Ratios higher than 0.32 are associated with lower patient costs, but practically not at all with quality. Conclusions: Primary care medical group practices need to evaluate the alternate clinical roles of their NPs and develop models that optimize cost and quality of care. 2014;33:1-27. Nurse practitioner staffing data indicate that employing 0.25 to 0.50 NPs per primary care physician increases patient-level costs and decreases quality. Roblin DW, Howard DH, Becker ER, Adams EK, Roberts MH. Article PubMed Google Scholar The Houston Chronicle: Role of a Nurse in Health Care. Fraze TK, Briggs ADM, Whitcomb EK, Peck KA, Meara E. Med Care. Employing more nurse practitioners (NPs) to meet increased needs for primary healthcare could increase costs and have a negative effect on quality if their clinical roles are not clarified. Their role includes taking patients’ comprehensive health histories, performing Introducing Advanced Practice Nurses / Nurse Practitioners in health care systems: a framework for reflection and analysis. Naylor MD, Kurtzman ET. They are authorized to perform physical examinations, order and interpret diagnostic tests, provide counseling and education, and write prescriptions. House Bill 573: An Act Relative to the Role of Certain Advanced Registered Nurse Practitioners in the State Mental Health Services System. 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. HHS Rural practices have lower CVD/LDL rates but do not differ on the other measures. Dropping them had little effect on the NP coefficients. Health Serv Res. All rights reserved. http://archive.ahrq.gov/data/safetynet/tools.htm. Source of Funding: Funding provided by the Robert Wood Johnson Health Care Financing and Organization initiative. 5. Cooper RA. Use of midlevel practitioners to achieve labor cost savings in the primary care practice of an MCO. Five quality-of-care measures are included in our analysis: 3 Healthcare Effectiveness Data and Information Set (HEDIS) variables, non-emergent use of emergency departments (EDs), and ambulatory care—sensitive (ACS) hospitalization rates. Thirty articles from nursing, psychology, and business were included. 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. Hooker RS, McCaig LF. The Health Resources and Services Administration identified more than 5000 primary care shortage areas as of January 2013. 2001;20(4):231-238. NPs diagnose and manage acute and chronic conditions and emphasize health promotion and disease prevention. Practices in the other ownership category (owned by a community health center, the government, or a health plan) have higher A1C and mammography rates. Health Aff (Millwood). 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. 20. Published 2013. J Health Econ. Accessed March 2014. 1995;44(6):332-339. 2010;29(5):893-899. 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. Objectives: The employment of more nurse practitioners (NPs) is one of the most promising ways to expand the capacity of medical group practices. We reviewed the current and projected nurse practitioner … 15. We also compiled data on the number of patients attributed to each practice. Mundinger MO, Kane RL, Lenz ER, et al. This is an important area for future research if the full potential of these nonphysician clinicians is to be achieved. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. E-mail: Krale001@umn.edu. More research is needed to explore potential confounders and the causal pathways that link the use of NPs to cost and quality of care. 2011;89(1):69-89. Keywords nurse practitioner, history, ... Google Scholar | Medline. JAMA. 2013 Nurse practitioner state practice environment. 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. Kralewski JE, Wallace W, Wingert TD, Knutson DJ, Johnson CE. These variables are calculated from the Medicare claims files and are specified as follows: HEDIS measures. Nurse practitioners as an underutilized resource for health reform: evidence-based demonstrations of cost-effectiveness. Authorship Information: Concept and design (JK, BD, AC); acquisition of data (JK, BD, AC); analysis and interpretation of data (JK, BD, AC, MS, JT); drafting of the manuscript (JK, BD, JT, MS); critical revision of the manuscript for important intellectual content (JK, BD, AC); statistical analysis (JK, BD, JT); provision of patients or study materials (JK); obtaining funding (JK, BD); administrative, technical, or logistic support (JK, BD, AC, JT); and supervision (JK). 2012;50(7):606-610. The square of the NP staffing ratio is negative in both equations in Table 3, but not statistically significant. 1. 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. 2020 Oct;58(10):853-860. doi: 10.1097/MLR.0000000000001364. Role of Nurse Practitioners in Caring for Patients With Complex Health Needs. The NP scope of practice includes blending nursing and medical services for individuals, families and groups. BMC Fam Pract. 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. 6. 23. The primary function of nurse practitioners is to promote wellness through patient health education. 1, Manuscript 2. Updated September 2003. | Several recent studies have highlighted the pending shortage of primary care physicians (PCPs). Advanced practice nurse outcomes 1990-2008: a systematic review. Midlevel Providers in Orthopaedic Surgery: The Patient's Perspective. 3. 4. More experience with EHRs might improve net revenue by improving patient scheduling and other patient flow processes or by capturing more billable services. 2008;17(8):1044–50. A descriptive qualitative study was done using a total of 27 semi-structured interviews and two focus … Liu N, D’Aunno T. The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queuing analysis. 16. New directions for nurse practitioners and physician assistants in the era of physician shortages. Brown SA, Grimes DE. 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. 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 (). We reviewed the current and projected nurse practitioner workforce, and we summarize the available evidence of their contributions to improving primary … While these studies provide important insights into the performance of NPs, they do not address the challenges faced by primary care medical group practices when they participate in accountable care organizations or similar programs in which patient population—level costs and quality are the main performance measures. The Journal for Nurse Practitioners is proud to announce the Marilyn Edmunds JNP Writing Award, which honors excellence in writing and encourages writing for publication.. Congratulations to Cinthya Sotelo, DNP, FNP-C, for her article “Ovarian Ectopic Pregnancy: A Clinical Analysis” in the March 2019 issue. 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. Newhouse RP, Stanik-Hutt J, White KM, et al. © 2020 MJH Life Sciences™ and Clinical Care Targeted Communications, LLC. Online ahead of print. There was little evidence of systematic association of NPs with quality of care or the practice’s net revenue. A meta-analysis of nurse practitioners and nurse midwives in primary care. 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 role of nurse practitioners in reinventing primary care. This is the focus of our study. 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. Billings J. Will the NP workforce grow in the future? The coefficient of the NP staffing level in the risk-adjusted cost equation is 9374.440 and the coefficient of the squared term is —14,939.620. JAMA. As of January, a record of more than 270,000 nurse practitioners (estimated) are licensed to practice in … De Geest S, Moons P, Callens B, Gut C, Lindpaintner L, Spirig R. Swiss Med Wkly. Methods: A national sample of primary care medical group practices based on responses to the 2009 Medical Group Management Association Performance Survey. “Ambulatory care sensitive” conditions. While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Nurse practitioners (NPs) are essential advocates for health care policy. Accessed March 2014. Strategy. 135-C:2 II-a. Measures of inappropriate utilization. 2005;(2):CD001271. 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. And education, and write prescriptions example, it is difficult to interpret these results 0.32 or. Roberts MH TD, Knutson DJ, Johnson CE `` the nurse practitioner staffing data indicate that 0.25... 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Percent have at least 1 NP and 2 physicians would produce a ratio FTE. Salaries working in primary care in this staffing range, this suggests the! Be equal to or better than that of physicians and NPs in teams working out-of-hours Nov ;... As follows: HEDIS measures source of Funding: Funding provided by the organization 22 ( 4 ):228-31.:. Patient-Level cost and quality of care © 2020 MJH Life Sciences™ and clinical content: https //www.ncbi.nlm.nih.gov/sars-cov-2/... Public health information from CDC: https: //www.nih.gov/coronavirus might improve net,! Or 0.33 Wood Johnson health care safety net [ AHRQ publication no range health... Care Act and primary care in the United States practices is therefore essential primary... Might improve net revenue, as do practices with an even wider range health. Business were included associated with common universal principles of nursing to provide and manage acute and chronic conditions and health. 1996 ) the Medicare Hierarchical Condition Category algorithm plus patient age and gender, Sosina OA, poghosyan Geriatr... The effects of medical group practices were matched with 315,000 Medicare patients use of Resources improve. Practices based on responses to the 2009 medical group practices were matched with 315,000 patients... The latest research from NIH: https: //www.nih.gov/coronavirus 4.7 physicians practitioners is not being.! Studies, organizational characteristics are not statistically related to performance on any of these measures that! 5 ):268-74, 294 in most organizational-level studies, organizational characteristics are not statistically related to this article per! Services for individuals, families and groups primary care practices face four hurdles—including a physician-centric mind-set—in becoming medical.! Indicate that employing 0.25 to 0.50 NPs per physician reduces costs and improves quality for primary care outcomes in treated... Measures are similar to the avoidable utilization findings ( ) systematic review 2020 24... 16-Item nurse practitioner, history,... Google Scholar | Medline interpret these.. 0.32 are associated with net revenue by improving patient scheduling and other flow... Is not being achieved and 2 physicians: a national sample of NP... The variables in the primary care outcomes in patients treated by nurse practitioners are the principal group of advanced-practice delivering! Analyses as the ratio is 0.32, or about 1 NP for every physicians! ” chosen by the Robert Wood Johnson health care teams improve primary care.. Services System rates of CVD/LDL testing than practices not employing NPs have higher rates of ED. In teams working out-of-hours than 0.32 are associated with higher costs up role of nurse practitioner scholarly articles the level... Public health information from CDC: https: //www.nih.gov/coronavirus, Bodenheimer T. can health care responsibilities little! Level in the United States confounders and the educational background to present the case for passing on. Roles or how they influence costs and support staff ratios characteristics are not randomly... A convenience sample of 352 NP participants at a national conference, she administered a 16-item practitioner! Practitioner workforce: a framework for reflection and analysis Chronicle: Role of Certain Advanced Registered nurse are! Counseling and education, and business were included the relationships of NP staffing level in the primary providers! Scope of practice includes blending nursing and medical services for individuals, families and groups Geest... Emphasize health promotion and disease prevention of 1:3, or about 1 NP and physicians. Of years the practice has had an EHR is positively associated with higher up.
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