Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians

Buerhaus, Peter I.; Perloff, Jennifer; Clarke, Sean P.; O’Reilly-Jacob, Monica; Zolotusky, Galina; DesRoches, Catherine M.

doi:10.1097/mlr.0000000000000908

Cited by 91 publications

(108 citation statements)

References 24 publications

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“…Prior studies suggest that provider characteristics (eg, gender, type), as well as practice size and network affiliation can influence the quality of primary care delivered. 33 - 37 As such, to balance practice-level characteristics, covariates included count of each clinician type, proportion of clinicians that was female, and network affiliation. We then calculated inverse probability of treatment weights (IPTWs) using the estimated propensity scores.…”

Section: Methodsmentioning

confidence: 99%

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

Nguyen

Chien

Meyers

et al. 2020

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Team-based care has emerged as a promising strategy for primary care practices to provide high-quality care. We examine changes in patient experience of care and recommended cancer screening rates associated with a primary care transformation initiative that established team-based care. Our observational study included 13 academically affiliated primary care practices in the Boston, Massachusetts area that participated in 2 learning collaboratives: the first (2012-2014) aimed to establish team-based primary care, while the second (2014-2016) focused on improving patient safety and cancer screening. We identified 37 comparison practices of similar size and network affiliation. Using a difference-in-differences approach, we compared pre (2013) and post (2015) patient experience and recommended cancer screening rates between intervention and comparison practices. We estimated linear regression models, using inverse probability weighting to balance on observable differences. Massachusetts Health Quality Partners data on patient experience comes from surveys (with communication, integration, knowledge of patient, access, office staff, and willingness to recommend domains), and its data on screening rates for breast, colorectal, and cervical cancers is derived from chart abstraction. Relative to comparison practices, the communication score in intervention practices increased by 1.47 percentage points on a 100-point scale ( P = .02) between pre and post periods. We did not detect immediate improvements in other measures of patient experience of care and recommended cancer screening rates. Communication may be the first dimension of patient experience that improves following establishment of team-based primary care, and changing care processes may require more time or attention in the transition to team-based care. Our findings also suggest a need to better understand the variation in implementation factors that facilitate some practices’ successful transitions to team-based care, and to use teams effectively to improve cancer screening processes.

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Section: Methodsmentioning

confidence: 99%

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

Nguyen

Chien

Meyers

et al. 2020

INQUIRY

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“… 21 , 34 , 35 Studies of transitional care have focused on the post-acute care population transitioning from one setting to another, with NPs providing transitional care supplemental to the care delivered by the primary care providers. 20 , 36 Although substantial evidence has shown that NPs provide quality of care similar to that of physicians, 37 , 38 even with medically complex patients 39 most of these studies have focused on acute care 40 or ambulatory care, 41 , 42 and these findings are not generalizable to care provided in a patient's home environment which presents unique challenges. 34 …”

Section: Introductionmentioning

confidence: 99%

The outcomes of nurse practitioner (NP)-Provided home visits: A systematic review

et al. 2020

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Background With the shortage of primary care providers to provide home-based care to the growing number of homebound older adults in the U.S. Nurse Practitioners (NPs) are increasingly utilized to meet the growing demand for home-based care and are now the largest type of primary care providers delivering home-visits. Purpose The purpose of this study was to systematically examine the current state of the evidence on health and healthcare utilization outcomes associated with NP-home visits. Method Five Databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library) were systematically searched to identify studies examining NP-home visits. The search focused on English language studies that were published before April 2019 and sought to describe the outcomes associated with NP-home visits. We included experimental and observational studies. Quality appraisal was performed with the Kmet, Lee & Cook tool, and results summarized qualitatively. The impact of NP-home visits on clinical (functional status, quality of life [QOL]), and healthcare utilization (hospitalization, Emergency department(ED) visits) outcomes was evaluated. Results/Discussion A total of 566 citations were identified; 7 met eligibility criteria and were included in the review. The most commonly reported outcomes were emergency department (ED) visits and readmissions. Given the limited number of articles generated by our search and wide variation in intervention and outcomes measures. NP-home visits were associated with reductions in ED visits in 2 out of 3 studies and with reduction in readmissions in 2 out of 4 studies. Conclusion Published studies evaluating the outcomes associated with NP-home visits are limited and of mixed quality. Limitations include small sample size, and variation in duration and frequency of NP-home visits. Future studies should investigate the independent effect of NP-home visits on the health outcomes of older adults using large and nationally representative data with more rigorous study design.

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“…8,9 Primary care physicians may play an especially important role in managing an aging population with multiple complex conditions. 10,11 In the early 1970s, internal medicine (IM) primary care residency programs and tracks were developed to help produce more primary care internists. 12 Recent evidence suggests that graduates of IM primary care programs are twice as likely to pursue primary care careers than their categorical IM resident colleagues.…”

Section: Introductionmentioning

confidence: 99%

A National Survey of Internal Medicine Primary Care Residency Program Directors

et al. 2019

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Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians

Abstract: The quality of primary care varies by clinician type, with different strengths for PCNPs and PCMDs. These comparative advantages should be considered when determining how to organize primary care to Medicare beneficiaries.

Cited by 91 publications

References 24 publications

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

The outcomes of nurse practitioner (NP)-Provided home visits: A systematic review

A National Survey of Internal Medicine Primary Care Residency Program Directors

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