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.
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.
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