Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

Fraze, Taressa; Briggs, Adam; Whitcomb, Elizabeth K.; Peck, Kristen A.; Meara, Ellen

doi:10.1097/mlr.0000000000001364

Cited by 23 publications

(31 citation statements)

References 38 publications

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“…The growth of nurse practitioners and other non-physician clinicians in rural settings has likely helped ensure patients can access care. 33,34 Considering the rural health care workforce is aging and fewer new physicians join rural practices, policymakers should remain focused on ensuring there is a sufficient primary care workforce pipeline in rural settings. 35 There has been concern that lack of access to primary care in rural settings could result in delays in seeking care which could exacerbate chronic conditions and/or greater utilization at more costly, hospital-based settings.…”

Section: Discussionmentioning

confidence: 99%

Configuration and Delivery of Primary Care in Rural and Urban Settings

et al. 2022

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Background There are concerns about the capacity of rural primary care due to potential workforce shortages and patients with disproportionately more clinical and socioeconomic risks. Little research examines the configuration and delivery of primary care along the spectrum of rurality. Objective Compare structure, capabilities, and payment reform participation of isolated, small town, micropolitan, and metropolitan physician practices, and the characteristics and utilization of their Medicare beneficiaries. Design Observational study of practices defined using IQVIA OneKey, 2017 Medicare claims, and, for a subset, the National Survey of Healthcare Organizations and Systems (response rate=47%). Participants A total of 27,716,967 beneficiaries with qualifying visits who were assigned to practices. Main Measures We characterized practices’ structure, capabilities, and payment reform participation and measured beneficiary utilization by rurality. Key Results Rural practices were smaller, more primary care dominant, and system-owned, and had more beneficiaries per practice. Beneficiaries in rural practices were more likely to be from high-poverty areas and disabled. There were few differences in patterns of outpatient utilization and practices’ care delivery capabilities. Isolated and micropolitan practices reported less engagement in quality-focused payment programs than metropolitan practices. Beneficiaries cared for in more rural settings received fewer recommended mammograms and had higher overall and condition-specific readmissions. Fewer beneficiaries with diabetes in rural practices had an eye exam. Most isolated rural beneficiaries traveled to more urban communities for care. Conclusions While most isolated Medicare beneficiaries traveled to more urban practices for outpatient care, those receiving care in rural practices had similar outpatient and inpatient utilization to urban counterparts except for readmissions and quality metrics that rely on services outside of primary care. Rural practices reported similar care capabilities to urban practices, suggesting that despite differences in workforce and demographics, rural patterns of primary care delivery are comparable to urban.

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Section: Discussionmentioning

confidence: 99%

Configuration and Delivery of Primary Care in Rural and Urban Settings

et al. 2022

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“…NPs are ideally suited to care for HNHC patients with complex and overlapping medical, behavioral, and social needs given their training in comprehensive and holistic care which emphasizes managing a patient's broad health needs as well as their social and emotional well-being (Grant et al, 2017). NPs are also more likely to care for Medicare beneficiaries with multiple chronic conditions -many of whom are HNHC (Fraze et al, 2020).…”

Section: Optimizing the Nurse Practitioner Workforcementioning

confidence: 99%

“…Indeed, NPs are significantly more likely to care for patients with three or more chronic conditions compared to physicians (25.9% vs 20.8%;Fraze et al, 2020), and deliver chronic disease services such as disease education and counseling (Lin et al, 2004;Ritsema et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients

et al. 2022

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Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients Ani Bilazarian BackgroundPrimary care practices in the United States (US) are currently constrained in their ability to deliver high quality care due to population aging, insurance expansion, and an increasing prevalence of chronically ill patients. The nurse practitioner (NP) workforce plays a critical role in meeting the growing demands for primary care, particularly in rural and underserved areas.NPs are also more likely to deliver care to clinically and socially complex populations such as high-need high-cost (HNHC) patients. HNHC patients are adults who suffer from multiple chronic conditions and experience additional functional, behavioral, or socioeconomic needs.Despite comprising only 5% of the US population, HNHC patients account for nearly half of total health care expenditures and over 90% of Medicare expenditures. HNHC patients with behavioral health diagnoses such as depression or substance abuse face heightened challenges managing their conditions and consequentially have higher preventable spending and emergency department (ED) utilization compared to the overall HNHC population.Significant policy attention has been placed on enhancing primary care practices as a strategy to improve outcomes and reduce costs in HNHC patients. Structural capabilities are features of primary care practices (e.g., after-hours care or care coordination) which are needed to deliver high quality primary care and chronic disease management. Yet, to date little research has been done on structural capabilities in primary care practices where NPs deliver care to HNHC patients. The overall purpose of this dissertation is to understand how to enhance primary care delivery and structural capabilities to improve outcomes for HNHC patients. We have achieved the following specific aims: (1) Establish a clear definition of HNHC patients, (2) Identify existing primary care and payment models used among HNHC patients and evaluate their impact on ED utilization and costs, (3) Evaluate structural capabilities in NP primary care practices located in Health Professional Shortage Areas (HPSAs), and ( 4) Analyze the association between NP practice structural capabilities and ED utilization among HNHC patients with behavioral health conditions. Dissertation Chapters and Key FindingsChapter One includes an introduction to the landscape of current primary care delivery, the role of the NP workforce in expanding access, and the unique challenges of delivering care to HNHC patients. This chapter also discusses the conceptual framework guiding the dissertation, the specific aims of each study, and how each study will fill a gap in the literature.Chapter Two (Aim 1) consists of a concept analysis of HNHC patients using the Walker and Avant framework. Three subgroups of HNHC patients were identified: adults over the age of 65 who suffer from multiple chronic conditions with functional or behavioral health needs, the frail elderly,...

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“…In all healthcare systems around the globe, nurses are important healthcare professionals who are responsible for the provision of large volumes of services to patients including those with epilepsy [ 10 , 11 ]. In today’s healthcare systems, nurses provide healthcare services to patients in primary, secondary, tertiary, and within highly specialized domains of healthcare settings [ 12 ]. Nurses also became part of multi-disciplinary healthcare teams in centers that provide comprehensive and holistic healthcare to patients with epilepsy [ 10 , 11 , 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Using a mixed method to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs

Shawahna

2021

BMC Med Educ

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Background Knowledge deficits with regard to epilepsy have been reported among healthcare professionals. This study was conducted to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs. Methods A mixed method which combined a thorough search of literature, the nominal group technique, the Delphi technique, and survey of students’ agreement was used. The databases MEDLINE/PUBMED, EMBASE, COCHRANE, CInAHL/EBESCO, SCOPUS, Google Scholar, Google Books, and Amazon were searched to identify potential aims, topics/contents, intended learning outcomes, teaching, and evaluation methods. Discussions and deliberations in serial meetings based on the nominal group technique were attended by educators/academicians (n = 12), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 2), and students in postgraduate and continuing education programs (n = 7) to supplement and refine the data collected from the literature. The qualitative data were analyzed using RQDA tool for R. The Delphi technique was used among educators/academicians (n = 15), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 3), and students in postgraduate and continuing education programs (n = 8) to achieve formal consensus. Results Consensus was achieved on 6 aims, 16 intended learning outcomes, and 27 topics in the course. Of the topics, 13 were relevant to nature of epilepsy and seizures, 2 were relevant to the impact of epilepsy and seizures on different life aspects of patients with epilepsy, 4 were relevant to advocating for the patients and supporting their choices, 5 were relevant to educating patients and their caregivers, and 3 were relevant to assessments and services. Conclusion Consensus-based aims, topics/contents, intended learning outcomes, teaching, and evaluation methods of a course on epilepsy for postgraduate or continuing education in community health nursing programs were developed. Consensus-based courses could bridge knowledge gaps and improve educating community health nursing programs on epilepsy. Further studies are needed to determine if such consensus-based courses could promote care of patients with epilepsy.

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Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

Cited by 23 publications

References 38 publications

Configuration and Delivery of Primary Care in Rural and Urban Settings

Configuration and Delivery of Primary Care in Rural and Urban Settings

Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients

Using a mixed method to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs

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