Estimating the Effect of the New York State Nurse Practitioners Modernization Act on Care Received by Medicaid Patients

2021 ◽  
pp. 152715442110181
Author(s):  
Edward Joseph Timmons ◽  
Conor Norris ◽  
Grant Martsolf ◽  
Lusine Poghosyan
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioners ◽  
New York State ◽  
Primary Care Providers ◽  
Care Providers ◽  
York State ◽  
More Care ◽  
Total Care ◽  
The Impact

The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. health care system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. New York State (NYS) changed its regulatory environment for NPs in 2015. We estimate the impact of expanded NP scope of practice (SOP) regulations in NYS on total care days received by Medicaid beneficiaries from 2015 to 2018 using a model derived from national historical data from 1999 to 2011. We used a longitudinal data policy analysis framework and a generalized difference-in-differences model to identify the effect of changes in NP SOP regulations on total care days. The model included controls for state income and unemployment rates. Our results suggest that the policy change increased total care days provided to patients, but that this difference was not statistically significant and became negligible after computing the number of days per beneficiary. In addition, our results suggest that had NYS moved to a full practice environment, more care days could have been provided to Medicaid patients, and this difference was found to be statistically significant. Our results suggest that states should adopt full NP SOP practice environments to realize measurable benefits of expanded NP SOP.

scholarly journals Relationship Between COVID-19 Cases and Vaccination Rates in New York State Counties

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Halle Cerio ◽  
Laura A. Schad ◽  
Telisa M. Stewart ◽  
Christopher P. Morley
Keyword(s):  
New York ◽  
Population Size ◽  
New York State ◽  
Primary Care Providers ◽  
Outcome Variable ◽  
Care Providers ◽  
York State ◽  
Vaccination Rates ◽  
County Population ◽  
The Impact

Introduction: Vaccines against SARS-CoV-2 have been developed with unprecedented speed. The phased introduction of vaccines may be serving to offset the impact of new viral variants and policy relaxation. In order to assess the impact of vaccination, we examined a snapshot of vaccination rates across counties in a single state, at a single time point, comparing them with population-adjusted case counts. Methods: We calculated descriptive statistics and bivariate correlations for vaccination rates and cases across counties in New York State (NYS). We conducted a linear regression using cases/100K population per NYS county, frozen at a single snapshot in time, as the outcome variable, predicted by percentage of each county’s population (completed series/two doses), controlling for county population. Results: Percentages with one dose and with two doses were highly correlated (r=.935, P<.001) with one another. Both the one dose and two dose z rates were negatively correlated with cases per 100K population (not significant). Population size was strongly correlated with cases per 100K (r=.715, P<.001). The two-dose vaccination rate was a significant negative predictor of cases per 100K population in NYS counties (β= -.866, P=.031), with each percentage point of completed vaccination nearly equating to one case less in the daily count when controlling for county population size (β =2.732, P<.001). Conclusion: While variants may impact vaccine effectiveness, current vaccination efforts are helping forestall some cases in NYS. Widespread vaccination is still an important goal. Primary care providers, public officials, and public health scientists should continue to urgently promote and support vaccination efforts.

Improving Primary Care Access to Respirologists Using eConsult

2021 ◽  
Author(s):  
Jean-Grégoire Leduc ◽  
Erin Keely ◽  
Clare Liddy ◽  
Amir Afkham ◽  
Misha Marovac ◽  
...  
Keyword(s):  
Primary Care ◽  
Median Time ◽  
Nurse Practitioners ◽  
Clinical Course ◽  
Primary Care Providers ◽  
Clinical Question ◽  
Care Providers ◽  
Provider Perspectives ◽  
Course Of Action ◽  
The Impact

Abstract Background: Patients and primary care providers (PCP) can experience frustration about poor access to specialist care. The Champlain Building Access to Specialists through eConsultation (BASETM) is a secure online platform that allows PCPs to ask a clinical question to 142 different specialty groups. The specialist is expected to respond within 7 days. Methods: This is a retrospective review of the Champlain BASETM respirology eConsults from January 2017 to December 2018. The eConsults were categorized by types of question asked by the referring provider, and by the clinical content of the referral. Specialists’ response time and time spent answering the clinical question was analyzed. Referring providers close out surveys were reviewed to assess the impact of the respirology eConsult service on traditional referral rates and clinical course of action. Results: Of the 26,679 cases submitted to the Champlain BASE TM eConsult service 268 were respirology cases (1%). 91% were sent by family physicians, 9% by nurse practitioners. The median time to respond by specialists was 0.8 days, and the median time billed by specialists was 20 minutes. The most common topics were pulmonary nodules and masses (16.4%), cough (10.4%), infective problems (8.6%), COPD (8.6%) and dyspnea NYD (7.8%). The most common types of question asked by PCP were related to investigations warranted (43.1% of cases), general management (17.5%), monitoring (12.6%), need for a respirology referral (12.3%), and drug of choice (6.3%). In 23% of cases the PCP indicated they were planning to refer the patient and no longer need to (avoided referrals) and in 13% of cases the PCP was not going to refer but did after receiving the eConsult advice (prompted referrals). The eConsult led to a new or additional clinical course of action by the PCP in 49% of cases. In 51% of cases the PCP suggested the clinical topic would be well suited to a CME event. Conclusions: Participation in eConsult services can improve timely access to respirologists while potentially avoiding clinic visit and significantly impacting referring PCPs clinical course of action. Using the most common clinical topics and types of question for CME planning should be considered. Future research may include a cost analysis, and provider perspectives on the role of eConsult in respirology care.

scholarly journals Hospitalization event notifications and reductions in readmissions of Medicare fee-for-service beneficiaries in the Bronx, New York

2016 ◽  
Vol 24 (e1) ◽  
pp. e150-e156 ◽  
Author(s):  
Mark Aaron Unruh ◽  
Hye-Young Jung ◽  
Rainu Kaushal ◽  
Joshua R Vest
Keyword(s):  
Primary Care ◽  
New York ◽  
Fixed Effects ◽  
Hospital Admissions ◽  
Primary Care Providers ◽  
Study Cohort ◽  
Fee For Service ◽  
Care Providers ◽  
Event Notification ◽  
The Impact

Objective: Follow-up with a primary care provider after hospital discharge has been associated with a reduced likelihood of readmission. However, primary care providers are frequently unaware of their patients’ hospitalizations. Event notification may be an effective tool for reducing readmissions by notifying primary care providers when their patients have been admitted to and discharged from a hospital. Materials and Methods: We examined the effect of an event notification system on 30-day readmissions in the Bronx, New York. The Bronx has among the highest readmission rates in the country and is a particularly challenging setting to improve care due to the low socioeconomic status of the county and high rates of poor health behaviors among its residents. The study cohort included 2559 Medicare fee-for-service beneficiaries associated with 14 141 hospital admissions over the period January 2010 through June 2014. Linear regression models with beneficiary-level fixed-effects were used to estimate the impact of event notifications on readmissions by comparing the likelihood of rehospitalization for a beneficiary before and after event notifications were active. Results: The unadjusted 30-day readmission rate when event notifications were not active was 29.5% compared to 26.5% when alerts were active. Regression estimates indicated that active hospitalization alert services were associated with a 2.9 percentage point reduction in the likelihood of readmission (95% confidence interval: −5.5, −0.4). Conclusions: Alerting providers through event notifications may be an effective tool for improving the quality and efficiency of care among high-risk populations.

scholarly journals The Psychological Impact of COVID-19 on Home Based Primary Care Providers in New York: A Qualitative Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 383-383
Author(s):  
Emily Franzosa ◽  
Sybil Masse ◽  
Abraham Brody ◽  
Jonathan Ripp ◽  
Katherine Ornstein ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioners ◽  
Psychological Impact ◽  
Well Being ◽  
Primary Care Providers ◽  
Personal Accomplishment ◽  
Care Providers ◽  
Home Based Primary Care ◽  
Home Based

Abstract Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.

scholarly journals Targeting the nurse practitioner workforce: Influences and barriers in choosing rural practice

2021 ◽  
Vol 12 (4) ◽  
pp. 51
Author(s):  
Mykell Barnacle ◽  
Allison Peltier ◽  
Heidi Saarinen ◽  
Christine Olson ◽  
Dean Gross
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Primary Care Providers ◽  
Rural Practice ◽  
Care Providers ◽  
Family Nurse Practitioner ◽  
Factors Influencing ◽  
Practice Readiness ◽  
The Impact

Background and objective: Recruitment and retention of primary care providers are projected to worsen in rural regions. Nurse practitioners (NPs) are a crucial solution to the shortage of primary care providers in rural America. Little research exists regarding factors influencing new NPs’ decisions to practice in rural settings, as well as practice readiness. The purpose of this study is to explore factors influencing new NPs’ decision to practice in rural settings.Methods: A survey of family nurse practitioner (FNP) graduates in a rural state was conducted. The survey measured rural background, current practice environment, the impact of rural clinical experiences on readiness to practice, and perceptions of rural NP practice.Results: The data collected over five years (N = 42) indicated several factors that influenced an NP’s decision to choose a position in a rural or underserved setting. A wide scope of practice, rural roots, a desirable job offer, and strong relationships were influential when choosing rural practice.Conclusions: Most respondents (69%) were not practicing in rural or underserved areas. Among those who were, the ability to practice to the full scope of education and autonomy were the most important factors. However, respondents were also apprehensive and intimidated with the broad skill set required in rural care. Implications: This study provides insight into factors and barriers for new graduate NPs in choosing a rural practice setting as well as possible solutions to the rural workforce shortage.

The effect of the global financial crisis on preventable hospitalizations among the homeless in New York State

2018 ◽  
Vol 23 (2) ◽  
pp. 80-86 ◽  
Author(s):  
Brandi White ◽  
Charles Ellis ◽  
Walter Jones ◽  
William Moran ◽  
Kit Simpson
Keyword(s):  
Primary Care ◽  
New York ◽  
Financial Crisis ◽  
Global Financial Crisis ◽  
New York State ◽  
Preventable Hospitalizations ◽  
York State ◽  
Hospitalization Rates ◽  
The Global Financial Crisis ◽  
The Impact

Objective Periods of economic instability may increase preventable hospitalizations because of increased barriers to accessing primary care. For underserved populations such as the homeless, these barriers may be more pronounced due to limited resources in the health care safety net. This study examined the impact of the global financial crisis of 2007–2008 on access to care for the homeless in New York State. Methods Hospitalizations for ambulatory care sensitive conditions (ACSCs) were used as a proxy measure for primary care access. Admissions for ACSCs were identified in the New York State Inpatient Database from 2006 to 2012. Hospitalization rates for ACSCs were calculated for the homeless and nonhomeless. Multivariable linear regression was used to investigate the impact of the financial crisis on hospitalization rates for ACSCs. Results The findings indicate that during the financial crisis, homeless adults had significantly higher preventable hospitalizations than nonhomeless adults, and the uninsured homeless had significantly higher preventable hospitalizations when compared to other homeless subgroups. After the financial crisis, preventable hospitalizations for the homeless stabilized but remained at higher rates than those for the nonhomeless. Conclusions These findings are important to developing health policies designed to provide effective care for underserved population such as the homeless.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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