scholarly journals Medical Care Delivery in US Nursing Homes: Current and Future Practice

2020 ◽  
Author(s):  
Paul R Katz ◽  
Kira Ryskina ◽  
Debra Saliba ◽  
Andrew Costa ◽  
Hye-Young Jung ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Medical Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Physician Assistants ◽  
Evidence Base ◽  
Standards Of Care ◽  
Organizational Models ◽  
Medical Provider ◽  
Provider Practice

Abstract The delivery of medical care services in US nursing homes (NH) is dependent on a workforce comprised of physicians, nurse practitioners (NP), and physician assistants (PA). Each of these disciplines operate under a unique regulatory framework while adhering to common standards of care. NH provider characteristics and their roles in NH care can illuminate potential links to clinical outcomes and overall quality of care with important policy and cost implications. This perspective provides an overview of what is currently known about medical provider practice in NH and organizational models of practice. Links to quality, both conceptual and established, are presented as is a research and policy agenda that addresses the gaps in the evidence base within the context of our ever-changing health care landscape.

scholarly journals Collaborative practice trends in US physician office visits: an analysis of the National Ambulatory Medical Care Survey (NAMCS), 2007–2016

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035414
Author(s):  
Shahpar Najmabadi ◽  
Trenton J Honda ◽  
Roderick S Hooker
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Nurse Practitioners ◽  
Healthcare Delivery ◽  
Physician Assistants ◽  
Collaborative Practice ◽  
Office Visits ◽  
Physician Office ◽  
Care Survey ◽  
Ambulatory Medical Care

ObjectivePractice arrangements in physician offices were characterised by examining the share of visits that involved physician assistants (PAs) and nurse practitioners (NPs). The hypothesis was that collaborative practice (ie, care delivered by a dyad of physician-PA and/or physician-NP) was increasing.DesignTemporal ecological study.SettingNon-federal physician offices.ParticipantsPatient visits to a physician, PA or NP, spanning years 2007–2016.MethodsA stratified random sample of visits to office-based physicians was pooled through the National Ambulatory Medical Care Survey public use linkage file. Among 317 674 visits to physicians, PAs or NPs, solo and collaborative practices were described and compared over two timespans of 2007–2011 and 2012–2016. Weighted patient visits were aggregated in bivariate analyses to achieve nationally representative estimates. Survey statistics assessed patient demographic characteristics, reason for visit and visit specialty by provider type.ResultsWithin years 2007–2011 and 2012–2016, there were 4.4 billion and 4.1 billion physician office visits (POVs), respectively. Comparing the two timespans, the rate of POVs with a solo PA (0.43% vs 0.21%) or NP (0.31% vs 0.17%) decreased. Rate of POVs with a collaborative physician-PA increased non-significantly. Rate of POVs with a collaborative physician-NP (0.49% vs 0.97%, p<0.01) increased. Overall, collaborative practice, in particular physician-NP, has increased in recent years (p<0.01), while visits handled by a solo PA or NP decreased (p<0.01). In models adjusted for patient age and chronic conditions, the odds of collaborative practice in years 2012–2016 compared with years 2007–2011 was 35% higher (95% CI 1.01 to 1.79). Furthermore, in 2012–2016, NPs provided more independent primary care, and PAs provided more independent care in a non-primary care medical specialty. Preventive visits declined among all providers.ConclusionsIn non-federal physician offices, collaborative care with a physician-PA or physician-NP appears to be a growing part of office-based healthcare delivery.

scholarly journals Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study

BMJ Open ◽  
2017 ◽  
Vol 7 (6) ◽  
pp. e015134 ◽  
Author(s):  
Marleen Hermien Lovink ◽  
Anke Persoon ◽  
Anneke JAH van Vught ◽  
Lisette Schoonhoven ◽  
Raymond TCM Koopmans ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Realist Evaluation

The LIVESTRONG essential elements of survivorship care: Advancing quality survivorship care in clinical care settings.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 155-155 ◽  
Author(s):  
Sarah R. Arvey ◽  
Ruth Rechis
Keyword(s):  
Iterative Process ◽  
Research Agenda ◽  
Care Delivery ◽  
Clinical Care ◽  
Evidence Base ◽  
Essential Elements ◽  
Standards Of Care ◽  
Survivorship Care ◽  
Distress Screening ◽  
Care Plans

155 Background: The American College of Surgeons Commission on Cancer (COC) has set a 2015 deadline for oncology practices to comply with new patient-centered standards of care to maintain accreditation. Despite this mandate, there is not a strong evidence base on best practices, or guidance on how to implement quality survivorship care services. In September 2011, the Lance Armstrong Foundation (LAF) and the LIVESTRONG Survivorship Center of Excellence Network (Network) convened researchers, providers, advocates, and cancer survivors who identified and prioritized a list of 20 Essential Elements of survivorship care. LAF and the Network continued work to refine this list with input from stakeholders with the goal of disseminating a framework for survivorship care delivery and advancing a research agenda to strengthen the evidence base for implementing these elements as standard care. Methods: LAF and the Network have refined definitions of the Essential Elements through an iterative process and in late 2012 will facilitate a technology-mediated consensus-building process among a broad group of stakeholders. Results: Refinement of the Essential Elements included defining each element in such detail that “basic” and “enriched” levels of implementation are described to guide providers in real-world settings. This work outlines a research agenda aimed to strengthen the evidence-base of the Essential Elements’ effectiveness in improving survivors’ outcomes. In October 2012, the refined definitions will be disseminated to a broad stakeholder audience and subject to review. Details of this iterative process, resulting definitions, and open-forum feedback will be reported here. Conclusions: Once complete, the Essential Elements will represent a consensus-driven platform that provides the cancer care community with a blueprint for the development and implementation of high-quality survivorship care and research. Additionally, the finalized Essential Elements will further facilitate the broad adoption of the new COC standards including the provision of a treatment summary and survivorship care plans, palliative care, psychosocial distress screening, and care coordination.

scholarly journals Provider Practice Models in Ambulatory Oncology Practice: Analysis of Productivity, Revenue, and Provider and Patient Satisfaction

2009 ◽  
Vol 5 (4) ◽  
pp. 188-192 ◽  
Author(s):  
Lori A. Buswell ◽  
Patricia Reid Ponte ◽  
Lawrence N. Shulman
Keyword(s):  
Patient Satisfaction ◽  
Nurse Practitioners ◽  
Cancer Care ◽  
Physician Assistants ◽  
Practice Analysis ◽  
Practice Models ◽  
Ambulatory Oncology ◽  
Provider Practice ◽  
Oncology Practice

Physicians, nurse practitioners, and physician assistants often work in teams to deliver cancer care in ambulatory oncology practices. This is likely to become more prevalent as the demand for oncology services rises, and the number of providers increases only slightly.

scholarly journals Physician assistants in geriatric medical care

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Andrzej Kozikowski ◽  
Trenton Honda ◽  
Freddi Segal-Gidan ◽  
Roderick S. Hooker
Keyword(s):  
Medical Care ◽  
Nurse Practitioners ◽  
Geriatric Medicine ◽  
Physician Assistants ◽  
National Commission ◽  
Chi Square ◽  
Extended Care ◽  
The Us ◽  
Rehabilitation Facilities

Abstract Background The US population is maturing. As of 2020, over 52 million (16%) people are age 65 or older. With a citizenry that is increasingly “gray,” the nation is short of medical providers who specialize in geriatric medical care. For example, the number of geriatrician physicians per 10,000 adults 65 years and older has decreased since 2000, with approximately 5300 in 2018. Nurse practitioners in geriatric medical care numbered 598 in 2018. Considering that the projected needs by 2030 will be over 30,000, the trajectory of geriatricians is becoming increasingly inadequate for the aging population. Physician assistants (PA) are another class of providers that are filling this geriatric medical care role, although little has been published. To address this role of PAs a study was undertaken. Methods The National Commission on Certification of Physician Assistants databank provided the number and characteristics of PAs in geriatric medicine and compared them to all other certified PAs. Analyses included descriptive statistics, Chi-Square, and Wilcoxon Rank Sum tests for comparisons between PAs practicing in geriatric medical care vs. all other PA specialties. Where a comparison between PAs in geriatrics and other specialties was made, a P value of .05 or less was considered statistically significant. Results As of 2018, there were 794 certified PAs, or 0.8% of the certified PA workforce, in geriatric medical care. This cadre has grown significantly since 2013, both in total number (increasing over 373%) and as a percentage of the PA workforce. The median age of certified PAs in geriatrics is 45 years, and 79% are female. Almost half (46%) of PAs in geriatric medicine work in extended care facilities or nursing homes, which differs from PAs in non-geriatric care. Another 8% work in government facilities and 8% in rehabilitation facilities. In 2018, the mean annual income for this PA group was $106,680. Conclusions As the American population continues to age, the relative growth of PAs in geriatric medicine makes them a natural part of the solution to the projected physician geriatrician deficit. The role of PAs in geriatric medical care remains to be explored.

Collaborating With Advanced Practice Providers: Impact and Opportunity

2017 ◽  
pp. e1-e7
Author(s):  
Heather M. Hylton ◽  
G. Lita Smith
Keyword(s):  
Nurse Practitioners ◽  
Cancer Care ◽  
Care Delivery ◽  
Quality Care ◽  
Cost Effective ◽  
Physician Assistants ◽  
Direct Patient Care ◽  
Advanced Practice ◽  
Care Access ◽  
Centered Care

Although significant progress has been made in cancer care, access to coordinated, high-quality care across the cancer care continuum remains a challenge for many patients. With significant workforce shortages in oncology anticipated, physician assistants (PAs) and nurse practitioners (NPs)—known collectively as advanced practice providers (APPs)—are considered to be a part of the solution to bridging the gap between the supply of and demand for oncology services. APPs are integral to the provision of team-based care in oncology, and optimizing the roles of all members of the patient’s care team is vital to ensuring the teams are cost-effective and that each team member is performing at the functional level intended. Studies have shown significant patient, physician, and APP satisfaction with collaborative care models, and APPs are well positioned to enhance value for patients in the oncology setting. Understanding the full scope of APP impact can be challenging as it extends well beyond direct patient care. As rapid progress in cancer care continues, innovative approaches to care delivery will be necessary to ensure patients’ access. Effective oncologist–APP partnerships will be key to providing optimal, value-centered care to patients.

scholarly journals Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study

2019 ◽  
Vol 21 (3) ◽  
pp. 282-290 ◽  
Author(s):  
Marleen H. Lovink ◽  
Anneke (J.A.H.) Vught ◽  
Anke Persoon ◽  
Raymond T.C.M. Koopmans ◽  
Miranda G.H. Laurant ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Qualitative Study ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Skill Mix

The Evolving Role of Advanced Practice Providers in Otolaryngology: Improving Patient Access and Patient Satisfaction

2021 ◽  
pp. 019459982110203
Author(s):  
Pratyusha Yalamanchi ◽  
Meredith Blythe ◽  
Kristi S. Gidley ◽  
William R. Blythe ◽  
Richard W. Waguespack ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Care Delivery ◽  
Physician Assistants ◽  
Neck Surgery ◽  
Physician Workforce ◽  
Advanced Practice ◽  
Patient Access ◽  
Few Data ◽  
Improve Access

The aging US population requires an increasing volume of otolaryngology–head and neck surgery services, yet the otolaryngologist physician workforce remains static. Advanced practice providers (APPs), including physician assistants and nurse practitioners, improve access across the continuum of primary and subspecialty health care. The rapid growth of APP service is evidenced by a 51% increase in APP Medicare billing for otolaryngology procedures over 5 years. APPs increasingly participate in delivering otolaryngology care; however, reaping the benefits of enhanced patient access and modernizing care delivery is predicated on successful integration of APPs into practices. Few data are available on how best to incorporate APPs into team-based models or how to restructure practices to allow graduated responsibility that supports autonomy and effective teamwork. We compare national APP and physician workforce trends in otolaryngology, consider approaches to optimizing efficiency by integrating APPs, and identify opportunities for improving data collection and practice.

Vertical Integration and Physician Practice Labor Composition

2020 ◽  
pp. 107755872097259
Author(s):  
Hilary Barnes ◽  
Grant R. Martsolf ◽  
Matthew D. McHugh ◽  
Michael R. Richards
Keyword(s):  
Vertical Integration ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Physician Assistants ◽  
Supporting Evidence ◽  
Physician Practice ◽  
Hospital Physician ◽  
Physician Practices ◽  
Physician Integration ◽  
Delivery Efficiency

With the growth of vertical integration among physician practices (i.e., hospital–physician integration), there have been many studies of its effects on health care treatments and spending. It is unknown if integration shapes provider configurations, especially against the backdrop of increasing employment of nurse practitioners (NPs) and physician assistants (PAs) across specialties. Using a longitudinal panel of 144,289 practices (2008-2015), we examined the association of vertical integration with NP and PA employment. We find positive associations between vertical integration and newly employing NPs and PAs within physician practices; however, the relationships differ by practice specialty type as well as timing of vertical integration. Supplementary analyses offer supporting evidence for coinciding enhancements to practice productivity, diversification, and provider task allocation. Our results suggest that vertical integration may promote interdisciplinary provider configurations, which has the potential to improve care delivery efficiency.

scholarly journals High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance

2019 ◽  
Vol 56 ◽  
pp. 004695801882506
Author(s):  
Robert Weech-Maldonado ◽  
Justin Lord ◽  
Rohit Pradhan ◽  
Ganisher Davlyatov ◽  
Neeraj Dayama ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Financial Performance ◽  
Nurse Practitioners ◽  
Fixed Effects ◽  
Market Competition ◽  
Physician Assistants ◽  
Occupancy Rate ◽  
Term Care ◽  
For Profit ◽  
Market Factors

High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services’ (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed.

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