With the increasing shortage of primary care physicians (MDs), nurse practitioners (NPs) have filled the gap in providing primary care. In our first three years of funding, we found that the number of older adults receiving care from NPs grew fifteen-fold between 1998 and 2010, and that there was substantial variation in the receipt of primary care from NPs across states. We also observed a strong association between state regulations of NP practice and the percent of patients receiving their primary care from NPs. Using potentially preventable hospitalization as a quality indicator to compare primary care delivered solely by NPs to care delivered by MDs in community dwelling patients with diabetes, we found that primary care provided by NPs was at least comparable to that provided by primary care physicians. The analyses from this initial funding period have focused on patients receiving their primary care exclusively from NPs vs. exclusively from MDs. We now wish to turn our attention to patients cared for by both disciplines in a shared care model. Interdisciplinary team care- comprised of NPs and MDs- has been promoted as a key to the success of new healthcare programs (e.g., Accountable Care Organizations (ACOs)) and payment models established under the Affordable Care Act (ACA). Randomized clinical trials (RCTs) have shown that the interdisciplinary team care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care for multiple encounters with various health care providers. How these models operate in more diverse patient populations and clinical settings, however, is unknown. Our proposed renewal study-the first national population-based investigation of interdisciplinary team models providing primary care in real-world patients- will address this critical gap in knowledge. We will focus on examining team primary care models and assessing the factors and outcomes associated with such models, in patients with chronic conditions (diabetes, congestive heart failure, and chronic obstructive pulmonary disease).
The specific aims are to: 1. Identify and characterize different team care models involving NPs and primary care physicians using social network analysis; 2. Determine patient, regional and health system factors associated with receiving care from NP-MD team care models; and 3. Examine the processes, outcomes and cost of care provided by NP-MD team care models compared with the traditional model involving primary care physicians only. To address these aims, we will use claims from national samples of Medicare beneficiaries from 2013 through 2016 to conduct this comparative effectiveness research.

Public Health Relevance

Interdisciplinary team care- comprised of NPs and MDs- has been promoted as a key to the success of new healthcare programs (e.g., ACOs) and payment models established under the ACA. We will use Medicare and other data to compare the processes, outcomes, and costs of care provided by NP-MD team care models versus the traditional model involving primary care physicians only.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS020642-06
Application #
9418578
Study Section
Healthcare Effectiveness and Outcomes Research (HEOR)
Program Officer
Bergofsky, Linda R
Project Start
2011-07-01
Project End
2020-02-29
Budget Start
2018-03-01
Budget End
2019-02-28
Support Year
6
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of Texas Med Br Galveston
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
800771149
City
Galveston
State
TX
Country
United States
Zip Code
77555
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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
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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
Raji, Michelle Y; Chen, Nai-Wei; Raji, Mukaila et al. (2016) Factors Associated With Seeking Physician Care by Medicare Beneficiaries Who Receive All Their Primary Care From Nurse Practitioners. J Prim Care Community Health 7:249-57
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
Kuo, Yong-Fang; Goodwin, James S; Chen, Nai-Wei et al. (2015) Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians. J Am Geriatr Soc 63:1980-8
Sharma, Gulshan; Meena, Ragai; Goodwin, James S et al. (2015) Burn injury associated with home oxygen use in patients with chronic obstructive pulmonary disease. Mayo Clin Proc 90:492-9
Kuo, Yong-Fang; Chen, Nai-Wei; Baillargeon, Jacques et al. (2015) Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians. Med Care 53:776-83

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