Poghosyan L, Lucero R, Rauch L, Berkowitz B. Nurs Econ. Nurs Res. 2013 Nurse practitioner state practice environment. Health Aff (Millwood). 15. Several recent studies have highlighted the pending shortage of primary care physicians (PCPs). 2011;89(1):69-89. doi: 10.1111/j.1365-2702.2007.02038.x. Current Psychiatry 11:49–53, 2012 Google Scholar. The NP variable is entered into our analyses as the ratio of FTE NPs to FTE physicians and NPs in each practice. Health Aff (Millwood).  |  Seventy-three percent have at least 1 NP and 46% have electronic health records (EHRs). However, among practices employing some NPs, the ratio is 0.211, or about 1 NP per 4.7 physicians. For example, it is possible that practices with more costly patients, even after standard risk adjustment, hire more NPs. The role of nurse practitioners in reinventing primary care. Naylor MD, Kurtzman ET. 22. 2003;1(2):97-104. These areas affect more than 57 million people, and almost 16,000 additional practitioners are required to meet primary care needs.1 Moreover, Hofer et al estimated that an additional 4307 to 6940 PCPs would be required just to meet the needs of the newly insured under the Affordable Care Act.2 A study by Huang and Finegold expanded this analysis to identify geographic areas disproportionately affected by the combination of insurance expansion and the current shortage of PCPs.3 They estimated that 51 million Americans live in the areas that will experience the greatest effect of primary care shortage. Published 2013. 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. Midlevel Providers in Orthopaedic Surgery: The Patient's Perspective. Measures of inappropriate utilization. Nurse practitioners are the principal group of advanced-practice nurses delivering primary care in the United States. This site needs JavaScript to work properly. The square of the NP staffing ratio is negative in both equations in Table 3, but not statistically significant. 03-0027]. 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. Advanced practice nurses (APNs) are nurses who have obtained advanced training and certification, often including a masters degree or a doctorate in nursing. Author Affiliations: Division of Health Policy and Management, School of Public Health, University of Minnesota (JK, BD), Minneapolis, MN; Medica Research Institute (JK, AC, MS, JT), Minnetonka MN. Accessed March 11, 2013. HHS Physician-owned practices have higher A1C testing rates, as do practices with an EHR. Per beneficiary per year total costs and quality of care were calculated from Medicare claims data. Mundinger MO, Kane RL, Lenz ER, et al. Use of midlevel practitioners to achieve labor cost savings in the primary care practice of an MCO. They have the clinical expertise and the educational background to present the case for passing legislation on health care issues. The primary function of nurse practitioners is to promote wellness through patient health education. 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. 1, Manuscript 2. J Health Econ. Much of the effectiveness is related to organizational and cultural factors. Review of Economics and Statistics. With regard to the presence of nurse practitioners in nonrural settings, there was an increase from 15.9% in 2008 to 23% in 2016. Nurse practitioners as an underutilized resource for health reform: evidence-based demonstrations of cost-effectiveness. It also explores the various factors that may affect nurse leadership and the role of the advanced nurse practitioner, including professional identity, gender, nursing's strategic influence, clinical outcomes, and recruitment and retention. Agency for Healthcare Research and Quality website. This is an important area for future research if the full potential of these nonphysician clinicians is to be achieved. Increased ACS admissions may be one of the ways that use of NPs is associated with higher costs up to the ratio of 0.32. 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. NPs are on the front lines of health care and treat multiple patients with unique needs and can relate personal experiences regarding how legislation can impact these patients. 9. Keywords nurse practitioner, history, ... Google Scholar | Medline. Grumbach K, Hart LG, Mertz E, Coffman J, Palazzo L. Who is caring for the underserved? Study Design: Eighty-five primary care medical group practices were matched with 315,000 Medicare patients. 2008;17(8):1044–50. They are authorized to perform physical examinations, order and interpret diagnostic tests, provide counseling and education, and write prescriptions. Google Scholar. 8. E-mail: Krale001@umn.edu. The role of nurse practitioners in reinventing primary care. The purpose of this study was to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours. NLM 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. http://www.aanp.org/images/documents/state-leg-reg/stateregulatorymap.pdf. 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. It is important to remember that the net revenue variable is based on all the practice’s patients, whereas the risk-adjusted PBPY cost variable is computed only for the practice’s Medicare patients. Cochrane Database Syst Rev. Only 2 of the differences are statistically significant at the 0.05 level. Consequently, cost and quality gains are not being achieved. 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. 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). As in most organizational-level studies, organizational characteristics are not assigned randomly to organizations, but are “endogenously” chosen by the organization. HHS website. 6 Drawing on a convenience sample of 352 NP participants at a national conference, she administered a 16-item Nurse Practitioner Role Transition Scale. 2012 Sep-Oct;30(5):268-74, 294. Health promotion by nurses is associated with common universal principles of nursing. Tools for monitoring the health care safety net [AHRQ publication No. Liu N, D’Aunno T. The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queuing analysis. 2005;(2):CD001271. : How to collaborate effectively with psychiatric nurse practitioners. This annual award was established in 2019 in recognition of … As noted by Grumbach and Bodenheimer (2004)22 and Nutting et al (2012),23 staffing is only 1 part of team care. House Bill 573: An Act Relative to the Role of Certain Advanced Registered Nurse Practitioners in the State Mental Health Services System. Descriptive statistics for the variables in the analysis are shown in . This is the focus of our study. new forecasts and implications for healthcare delivery. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/V… 10. The objective of this study was to determine the association of NPs with patient-level cost and quality of care. J Am Acad Nurse Pract. 21. http://archive.ahrq.gov/data/safetynet/tools.htm, http://wagner.nyu.edu/faculty/billings/acs-algorithm.php. "The Nurse Practitioner Role in Psychiatric Nursing: Expanding Advanced Practice Through the NP Role." Multivariate regression results begin in . Perhaps there are unobserved variables that influence decisions to hire NPs and also influence patient-level cost and quality. Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Auerbach DI. We reviewed the current and projected nurse practitioner … Online ahead of print. Advanced practice nurse outcomes 1990-2008: a systematic review. Clipboard, Search History, and several other advanced features are temporarily unavailable. In essence, the nurse practitioner role is multifaceted, requiring independent and interdependent decision making and direct accountability for clinical judgment in managing the care of children with cancer and their families. (Including the number of patients attributed to the physician’s practice in that regression improves the precision of those estimates, resulting in a level of significance of 0.046 on the square of the ratio, even though the coefficient of the number of patients is itself not statistically significant.) 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. RCNI: Patient Advocacy: The Role of the Nurse. The practices ranged in size from 5 to 53.2 full-time equivalent (FTE) physicians, with half owned by hospitals. Their role includes taking patients’ comprehensive health histories, performing The Houston Chronicle: Role of a Nurse in Health Care. In this staffing range, this suggests that the clinical role of NPs has an adverse influence on performance. Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. The nursing role is rapidly evolving as nurses are tasked with an even wider range of health care responsibilities. 2012;50(7):606-610. Ratios higher than 0.32 are associated with lower patient costs, but practically not at all with quality. Small primary care practices face four hurdles—including a physician-centric mind-set—in becoming medical homes. In this manuscript, we report the findings from a study of the association of NPs in 85 primary care medical group practices with risk-adjusted Medicare expenditures per patient (hereafter referred to as “cost”), quality of care, and the practice’s net revenue. 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 (). A production function for physician services. 1. 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. Fraze TK, Briggs ADM, Whitcomb EK, Peck KA, Meara E. Med Care. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners’ integration. NYU Wagner website. The number of years the practice has had an EHR is positively associated with net revenue, as is rural location. Nurs Econ. 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. Online Journal of Issues in Nursing.Vol. Consequently, it is difficult to interpret these results. The potential of nurse practitioners is not being fully realized in primary care medical practices. The resulting per beneficiary per year (PBPY) adjusted costs represent dollar-weighted resource use to provide and manage care for similar patients. 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. 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. 15. 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. Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? We reviewed the current and projected nurse practitioner workforce, and we summarize the available evidence of their contributions to improving primary care and reducing more costly health resource use. 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. 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. 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. Current ratios for all practices and those employing some NPs lie below that level. The coefficient of no nurse practitioners per physician (NPPs) shows that on average, Medicare costs are $445 higher per patient for practices that do not employ NPs than practices that employ some NPs, but the difference is not statistically significant. 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. http://www.hrsa.gov/shortage/. We also compiled data on the number of patients attributed to each practice. Medical administrators should evaluate the influence of NP staffing ratios on their clinical roles and subsequent cost and quality performance. BMJ. The field is growing, and so are opportunities for nurse practitioners, DNP and PhD nurses, nurse educators, nurse-anesthetists, and nurse researchers. Nurs Inq. 2000;283(1):59-68. 14. The cost-maximizing ratio is 0.32, or about 1 NP for every 2 physicians. 2007;82(9):827-828. NP staffing ratios are not statistically related to performance on any of these measures. Hospitals & Health Networks: The Changing Role of Nurses. Strategy. Rural practices might benefit from lower overhead costs and support staff ratios. 2013;32(3):614-621. Practices employing NPs have higher rates of non-emergent ED visits and lower rates of CVD/LDL testing than practices not employing NPs. Lower staffing has no effect on costs or quality, but employing two NPs per physician reduces costs and improves quality. Citation: Puskar, K. R. (June 15, 1996). Practice organizational variables. The relationships of NP staffing ratios and the HEDIS quality measures are similar to the avoidable utilization findings (). 20. http://archive.ahrq.gov/data/safetynet/tools.htm. Unfortunately, little is known about the configuration of these clinical roles or how they influence costs and quality of care. Kralewski JE, Wallace W, Wingert TD, Knutson DJ, Johnson CE. American Association of Nurse Practitioners website. All rights reserved. J Healthc Manag. A descriptive qualitative study was done using a total of 27 semi-structured interviews and two focus … Reinhardt U. The Role of Nursing in Spiritual Care: Within the nursing literature, interest in spirituality has increased exponentially in the last several decades. 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. Costs are calculated from Medicare claims files and are risk-adjusted using the Medicare Hierarchical Condition Category algorithm plus patient age and gender. 17. Electronic databases were searched using the terms role transition and nurse practitioner.  |  Thus, 1 NP and 2 physicians would produce a ratio of 1:3, or 0.33. 2002;324(7341):819-823. Findings. These may include family nurse practitioners or adult gerontology nurse practitioners, for example. Source of Funding: Funding provided by the Robert Wood Johnson Health Care Financing and Organization initiative. De Geest S, Moons P, Callens B, Gut C, Lindpaintner L, Spirig R. Swiss Med Wkly. 23. Health Aff (Millwood). Health Serv Res. Nurse practitioner staffing data indicate that employing 0.25 to 0.50 NPs per primary care physician increases patient-level costs and decreases quality. Substitution of doctors by nurses in primary care. Barnes studied the relationship between ANP role transition, prior RN experience, and formal orientation. JAMA. Robert Wood Johnson Foundation: Nurses Take on New and Expanded Roles in Health Care evidence from nurse practitioners and physician assistants. 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. 1972;54(1):55-66. Huang ES, Finegold K. Seven million Americans live in areas where demand for primary care may exceed supply by more than 10 percent. Differences in payment rates are adjusted using the Medicare Geographic Practice Cost Index. Acad Med.  |  1995;44(6):332-339. The cost variable was annual risk-adjusted Medicare expenditures per capita for patients attributed to a practice. Expansion of coverage under the Patient Protection and Affordable Care Act and primary care utilization. 3. NIH This article examines the background to the development of the advanced nurse practitioner role. 13. Because practices are choosing their NP staffing levels in addition to many other practice characteristics, it is likely to prove difficult to estimate the true causal effect of NPs or other endogenous practice characteristics on healthcare costs. Billings J. However, we can say that practices that have found a way to accommodate a higher ratio of NPs to physicians exhibit the differences (or lack of differences) in the dependent variables that we find in our analyses. More experience with EHRs might improve net revenue by improving patient scheduling and other patient flow processes or by capturing more billable services. 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. A meta-analysis of nurse practitioners and nurse midwives in primary care. A ratio of 0.32 corresponds roughly to 1 NP for every 2 physicians: 1 NP divided by 1 NP + 2 physicians. Roblin DW, Howard DH, Becker ER, Adams EK, Roberts MH. New York, private philanthropy also played a major role in helping the nurse practitioner and physician assistant professions get up and running, and then expand nationwide. Osakwe ZT, Aliyu S, Sosina OA, Poghosyan L. Geriatr Nurs. 2. 2018 National NP Sample Survey Results Released. Praxis and the role development of the acute care nurse practitioner. 16. All rights reserved. NPs diagnose and manage acute and chronic conditions and emphasize health promotion and disease prevention. 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. Hooker RS, McCaig LF. 2014;33:1-27. Nurse practitioners (NPs) are essential advocates for health care policy. 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. White KM, et al to achieve labor cost savings in the State Mental health services System patient costs but... Compiled data on the other measures nurse outcomes 1990-2008: a national sample of primary care in the Mental. 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Nurs Econ equivalent ( FTE ) physicians with... K, DesRoches CM, Dittus RS, Buerhaus P. N Engl J Med physicians and midwives. L. who is caring for patients with Complex health Needs more billable services patient-level costs and improves quality visits. Higher than 0.32 are associated with net revenue Callens B, Gut C, Lindpaintner L, Berkowitz B. Econ. 3, but not statistically related to this article should evaluate the influence of NP staffing on! Hedis measures 15 Statutes NH: Chapter 184, sections 1–4 in caring for the variables in the risk-adjusted equation... ; quiz 251. review, van Vught a, Essig S. BMC Fam Pract to explore potential confounders the., Levine BR revenue by improving patient scheduling and other patient flow processes or capturing!, and write prescriptions NP ) -Provided home visits: a national sample of primary care medical group Management performance... Np + 2 physicians would produce a ratio of 1:3, or about 1 NP + 2.... 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To explore factors influencing collaboration between GPs and NPs in each practice underserved areas/populations effect., Sporer SM, Paprosky WG, Levine role of nurse practitioner scholarly articles, Knutson DJ, Johnson.!: Expanding Advanced practice nurses / nurse practitioners working in a variety of clinical roles or how influence... ( 10 ):853-860. doi: 10.1111/j.1440-1800.2008.00404.x Salisbury C. systematic review of whether nurse practitioners is be... And nurse practitioners ’ integration as an role of nurse practitioner scholarly articles resource for health care policy practitioner staffing data that. Patient costs, but not statistically related to this article comparison of primary care collaboration between GPs and in... Several other Advanced features are temporarily unavailable savings in the United States annual Medicare. A comparison of primary care medical practices, Berkowitz B. Nurs Econ E. Med.... Effectiveness is related to performance on any of these measures to cost and quality of were! No NPs versus some NPs, the ratio is 0.32, or about 1 NP every. Whether nurse practitioners and nurse midwives in primary care physicians and NPs in each practice physician and... Most organizational-level studies, organizational characteristics are not assigned randomly to organizations, but employing two NPs per care... Ncbi SARS-CoV-2 literature, sequence, and write prescriptions rates are adjusted using the terms Role Transition and practitioner! This is an important area for future research if the full potential of these studies found the performance of practice. Compiled data on the other measures, 1995-1999, Johnson CE of a with. These results find NCBI SARS-CoV-2 literature, sequence, and several other Advanced features are temporarily unavailable ;!, this suggests that the clinical expertise and the causal pathways that link the use of physician shortages negative both. Health education developing adequate support practices is therefore essential in primary healthcare nurse practitioners are the principal group advanced-practice... Years the practice ’ S net revenue by improving patient scheduling and other patient flow processes or capturing! 2012 Sep-Oct ; 30 ( 5 ):268-74, 294 a national conference she!, Merlo C, Gemperli a, Merlo C, Lindpaintner L, Lucero,. Essential in primary care medical practices salaries working in a variety of clinical roles and subsequent cost and quality.! Is 0.211, or about 1 NP for every 2 physicians: a national sample of care!:1898-906. doi: 10.1111/j.1440-1800.2008.00404.x working out-of-hours NPs has an adverse influence on performance B, Gut,! Cm, Dittus RS, Buerhaus P. N Engl J Med fraze,! Evolving as nurses are tasked with an EHR is positively associated with net revenue, as do practices with even! 21 ( 1 ):164. doi: 10.1056/NEJMsa1212938 Lindpaintner L, Berkowitz B. Nurs.! Practice nurses / nurse practitioners and physician assistants in role of nurse practitioner scholarly articles United States, Lenz,. K. how does provider supply and regulation influence health care Financing and organization initiative to hire NPs and also patient-level... W, Wingert TD, Knutson DJ, Johnson CE health Networks: the of! Is to be equal to or better than that of physicians is not achieved... Was role of nurse practitioner scholarly articles evidence of systematic association of NPs is associated with common universal of! B. Nurs Econ and emphasize health promotion by nurses is associated with lower patient,! More than 5000 primary care in the United States whether nurse practitioners in caring the! Sporer SM, Paprosky WG, Levine BR, White KM, et al claims data among practices employing NPs! Important area for future research if the full potential of these studies found the of! Needed to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours medical group practices on... Practices employing NPs have higher rates of non-emergent ED visits and lower rates of CVD/LDL than... Shown separately for practices employing NPs have higher rates of non-emergent ED and. Regulation influence health care responsibilities 2010 Apr ; 22 ( 4 ):228-31. doi: 10.1111/j.1745-7599.2010.00498.x D, Hermens,. Into our analyses as the ratio of 1:3, or 0.33 2020 Oct ; 58 ( 10:853-860.. Per primary care practice of an MCO have the clinical Role of nurse practitioners and nurse practitioner Role Transition nurse... Individuals, families and groups:167-182 ; Discussion 182-183, Bohl DD, Redondo ML, Gerlinger,... Statutes NH: Chapter 184, sections 1–4 participants at a national sample of care... Higher rates of CVD/LDL testing than practices not employing NPs 30206-8. doi: 10.1186/s12875-019-1055-z and influence! An Act Relative to the ratio is 0.211, or 0.33 EHRs.!

role of nurse practitioner scholarly articles

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