An increasing shortage of primary care providers (PCP) is projected as the US population grows and ages. One approach to address the shortage is to increase the role of nurse practitioners (NP) as PCPs. Our preliminary data suggest a rapid growth in the percent of older patients who received outpatient care from NPs, from 0.4% in 1997 to 8.4% in 2008. By 2008, 2.5% of Medicare beneficiaries received the majority of their primary care from an NP. The rate of NP care varies substantially by geographic location. In 10 Hospital Referral Regions (HRRs), more than 10% of the elderly received the majority of their primary care from NPs, while less than 1% of the elderly received the majority of their care from NPs in 70 HRRs. NP practice is quite sensitive to state regulations. Compared with states with the most restrictive regulations, the odds of receiving the majority of primary care from NPs was three fold higher for beneficiaries in states with the most liberal regulations. Four of the five RCTs comparing care provided by NPs vs. physicians were conducted outside the US in different health care delivery systems, and the US study was from an academic health center. No national or population-based studies have yet assessed the processes, outcomes and costs of NP care.
Our Specific Aims are: 1. Compare process and quality of care provided by NPs and generalist physicians, with a focus on processes of primary and secondary prevention, and intensity and frequency of visits, potential inappropriate use of medication, adherence to key medications, and receipt of specialist consultations. 2. Compare outcomes of care between care provided by NPs and generalist physicians, focusing on hospitalizations for ambulatory care sensitive conditions. 3. Compare Medicare costs between care provided by NPs and generalist physicians. To address these aims, we will use claims from national samples of Medicare beneficiaries from 2006 through 2011 to conduct this comparative effectiveness research.
An increasing shortage of primary care providers is projected as the US population grows and ages. One approach to address the shortage is to increase the role of nurse practitioners in primary care. We will use Medicare and other data to assess the processes, outcomes, and costs for care provided by nurse practitioners, generalist physicians, or both in general practice.
|Bishwakarma, Raju; Zhang, Wei; Lin, Yu-Li et al. (2018) Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus. Int J Chron Obstruct Pulmon Dis 13:793-800|
|Singh, Gurinder; Agarwal, Amitesh; Zhang, Wei et al. (2018) Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA. Sleep Breath :|
|Nishi, Shawn P E; Maslonka, Matthew; Zhang, Wei et al. (2018) Pattern and Adherence to Maintenance Medication Use in Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease: 2008-2013. Chronic Obstr Pulm Dis 5:16-26|
|Kuo, Yong-Fang; Adhikari, Deepak; Eke, Chiemeziem G et al. (2018) Processes and Outcomes of Congestive Heart Failure Care by Different Types of Primary Care Models. J Card Fail 24:9-18|
|Loresto Jr, Figaro L; Jupiter, Daniel; Kuo, Yong-Fang (2017) Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data. J Am Assoc Nurse Pract 29:340-347|
|Xue, Ying; Goodwin, James S; Adhikari, Deepak et al. (2017) Trends in Primary Care Provision to Medicare Beneficiaries by Physicians, Nurse Practitioners, or Physician Assistants: 2008-2014. J Prim Care Community Health 8:256-263|
|Bishwakarma, Raju; Zhang, Wei; Kuo, Yong-Fang et al. (2017) Long-acting bronchodilators with or without inhaled corticosteroids and 30-day readmission in patients hospitalized for COPD. Int J Chron Obstruct Pulmon Dis 12:477-486|
|Agarwal, Amitesh; Zhang, Wei; Kuo, YongFang et al. (2016) Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician. PLoS One 11:e0148522|
|Singh, Gurinder; Zhang, Wei; Kuo, Yong-Fang et al. (2016) Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD. Chest 149:905-15|
|Nishi, Shawn P E; Zhang, Wei; Kuo, Yong-Fang et al. (2016) Pulmonary Rehabilitation Utilization in Older Adults With Chronic Obstructive Pulmonary Disease, 2003 to 2012. J Cardiopulm Rehabil Prev 36:375-82|
Showing the most recent 10 out of 20 publications