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Jin X, Pan Z, Hou S, Pang H, Dong A, Hu L, Brown S, Plester G, Chi C. The roles and responsibilities of general practice nurses in China: a qualitative study. BMC PRIMARY CARE 2024; 25:331. [PMID: 39243023 PMCID: PMC11378389 DOI: 10.1186/s12875-024-02591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND General hospitals in China have been establishing General Practice Departments (GPD). Although General Practice Nurses (GPNs) are an important part of this medical system, their training has not been synchronised. This study explored the working status of nurses in GPDs in general hospitals in Beijing to provide a theoretical basis for the training and development of GPNs in China. METHODS We conducted in-depth, individual interviews with outpatient nurses at 19 hospitals in Beijing between March and April 2021. We employed a qualitative analysis to interpret participant narratives and used a codebook thematic analysis to analyse the interview data and extract themes. RESULTS The analysis revealed four themes: (i) a lack of full-time GPNs in GPDs of most tertiary hospitals, (ii) the inability of GPNs to fully express their potential and skills owing to their limited roles, (iii) insufficient standardised patient education provided by nurses in GPDs, and (iv) a lack of systematic and relevant training for nurses working in general practice settings. CONCLUSIONS To promote the development of GPNs, GPDs in general hospitals in China should hire full-time GPNs, define their job duties in alignment with their values, and provide standardised training to strengthen their core competencies.
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Affiliation(s)
- Xue Jin
- Department of General Practice, Peking University First Hospital, Beijing, 100034, China
| | - Zihan Pan
- Department of General Practice, Peking University First Hospital, Beijing, 100034, China.
| | - Shuxiao Hou
- School of Nursing, Peking University, Beijing, 100191, China
| | - Hui Pang
- Emergency Department, Beijing Friendship Hospital, Capital Medical University, Beijing, 10050, China
| | - Aimei Dong
- Department of General Practice, Peking University First Hospital, Beijing, 100034, China
- Health Management Center, Peking University First Hospital, Beijing, 100034, China
| | - Lin Hu
- University of Birmingham, Birmingham, CV23 0QA, UK
| | | | | | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Beijing, 100034, China
- Health Management Center, Peking University First Hospital, Beijing, 100034, China
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Kosar CM, Thapa BB, Muench U, Santostefano C, Gadbois EA, Oh H, Gozalo PL, Rahman M, White EM. Nurse Practitioner Care, Scope of Practice, and End-of-Life Outcomes for Nursing Home Residents With Dementia. JAMA HEALTH FORUM 2024; 5:e240825. [PMID: 38728021 PMCID: PMC11087831 DOI: 10.1001/jamahealthforum.2024.0825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/07/2024] [Indexed: 05/13/2024] Open
Abstract
Importance Nursing home residents with Alzheimer disease and related dementias (ADRD) often receive burdensome care at the end of life. Nurse practitioners (NPs) provide an increasing share of primary care in nursing homes, but how NP care is associated with end-of-life outcomes for this population is unknown. Objectives To examine the association of NP care with end-of-life outcomes for nursing home residents with ADRD and assess whether these associations differ according to state-level NP scope of practice regulations. Design, Setting, and Participants This cohort study using fee-for-service Medicare claims included 334 618 US nursing home residents with ADRD who died between January 1, 2016, and December 31, 2018. Data were analyzed from April 6, 2015, to December 31, 2018. Exposures Share of nursing home primary care visits by NPs, classified as minimal (<10% of visits), moderate (10%-50% of visits), and extensive (>50% of visits). State NP scope of practice regulations were classified as full vs restrictive in 2 domains: practice authority (authorization to practice and prescribe independently) and do-not-resuscitate (DNR) authority (authorization to sign DNR orders). Main Outcomes and Measures Hospitalization within the last 30 days of life and death with hospice. Linear probability models with hospital referral region fixed effects controlling for resident characteristics, visit volume, and geographic factors were used to estimate whether the associations between NP care and outcomes varied across states with different scope of practice regulations. Results Among 334 618 nursing home decedents (mean [SD] age at death, 86.6 [8.2] years; 69.3% female), 40.5% received minimal NP care, 21.4% received moderate NP care, and 38.0% received extensive NP care. Adjusted hospitalization rates were lower for residents with extensive NP care (31.6% [95% CI, 31.4%-31.9%]) vs minimal NP care (32.3% [95% CI, 32.1%-32.6%]), whereas adjusted hospice rates were higher for residents with extensive (55.6% [95% CI, 55.3%-55.9%]) vs minimal (53.6% [95% CI, 53.3%-53.8%]) NP care. However, there was significant variation by state scope of practice. For example, in full practice authority states, adjusted hospice rates were 2.88 percentage points higher (95% CI, 1.99-3.77; P < .001) for residents with extensive vs minimal NP care, but the difference between these same groups was 1.77 percentage points (95% CI, 1.32-2.23; P < .001) in restricted practice states. Hospitalization rates were 1.76 percentage points lower (95% CI, -2.52 to -1.00; P < .001) for decedents with extensive vs minimal NP care in full practice authority states, but the difference between these same groups in restricted practice states was only 0.43 percentage points (95% CI, -0.84 to -0.01; P < .04). Similar patterns were observed in analyses focused on DNR authority. Conclusions and Relevance The findings of this cohort study suggest that NPs appear to be important care providers during the end-of-life period for many nursing home residents with ADRD and that regulations governing NP scope of practice may have implications for end-of-life hospitalizations and hospice use in this population.
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Affiliation(s)
- Cyrus M. Kosar
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Bishnu B. Thapa
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Ulrike Muench
- Department of Social Behavioral Sciences, University of California at San Francisco School of Nursing, San Francisco
| | - Christopher Santostefano
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Emily A. Gadbois
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Hyesung Oh
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Pedro L. Gozalo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Momotazur Rahman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth M. White
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
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Silva JBB, Riester MR, Zullo AR. Antibiotic Prescribing Patterns for Urinary Tract Infections and Pneumonia by Prescriber Type and Specialty in Nursing Home Care, 2016-2018. J Am Med Dir Assoc 2024; 25:769-773.e9. [PMID: 38428833 PMCID: PMC11259097 DOI: 10.1016/j.jamda.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To identify whether differences in antibiotic prescribing practices by prescriber type and specialization in nursing home (NH) care exist for urinary tract infection (UTI) and pneumonia. DESIGN Retrospective cohort. SETTING AND PARTICIPANTS This national study included antibiotic dispensings to traditional Medicare beneficiaries aged ≥65 years with UTI or pneumonia infections residing long-term (≥100 days) in US NHs between 2016 and 2018. METHODS Minimum Data Set assessment data were linked to Medicare data [Part D prescription drug, inpatient hospital (MedPAR), prescriber characteristics, and enrollment]. We compared antibiotic prescribing patterns by prescriber type [physician vs advanced practice practitioner (AP)] and NH specialization (≥90% vs <90% of all associated medication dispensings to NH residents). Antibiotic dispensing measures included the total number of dispensings and duration of therapy (median number of days supplied) by antibiotic class. RESULTS There were 264,735 antibiotic dispensings prescribed by 32,437 prescribers for 140,360 residents in 14,035 NHs. NH specialists were less likely to prescribe fluoroquinolones for UTI (22.9% NH specialist physician, 23.9% non-NH specialist physician, 21.3% NH specialist AP, 24.2% non-NH specialist AP), but more likely to prescribe fluoroquinolones for pneumonia (38.9%, 37.8%, 38.8%, 37.3%, respectively). Over time, NH specialists reduced fluoroquinolone prescribing for pneumonia to a greater extent than non-NH specialists. The duration of therapy was similar across prescriber groups for UTI, but longer among non-NH specialist APs for several antibiotic classes for pneumonia, including tetracyclines, glycopeptides and lipoglycopeptides, and metronidazole. CONCLUSIONS AND IMPLICATIONS There were differences in antibiotic prescribing patterns by prescriber type and specialization in NH care between 2016 and 2018. Understanding how antibiotic prescribing differs based on prescriber characteristics is essential to inform antibiotic stewardship efforts. Tailoring antibiotic stewardship efforts to prescribers by NH specialization is rational given differences in antibiotic prescribing patterns based on NH specialization.
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Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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Ryskina KL, Liang J, Ritter AZ, Spetz J, Barnes H. State scope of practice restrictions and nurse practitioner practice in nursing homes: 2012-2019. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae018. [PMID: 38426081 PMCID: PMC10901290 DOI: 10.1093/haschl/qxae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.
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Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Junning Liang
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ashley Z Ritter
- NewCourtland, Philadelphia, PA 19119, United States
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Joanne Spetz
- School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, United States
| | - Hilary Barnes
- Widener University School of Nursing, Chester, PA 19013, United States
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Yang BK, Idzik S, Nelson HW, McSweeney-Feld MH. Nurse Practitioner Employment in Relation to Nursing Staff Turnover and Resident Care Outcomes in US Nursing Homes. J Am Med Dir Assoc 2023; 24:1767-1772. [PMID: 37634548 DOI: 10.1016/j.jamda.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES A growing number of nurse practitioners (NPs) are employed in nursing homes (NHs) through various NP staffing mechanisms. The purpose of this study was to examine if having NH-employed NPs was associated with nursing staff turnover and resident care outcomes measured as hospital utilization, infection control citations, and substantiated complaints in NHs in 2021-2022. DESIGN A cross-sectional, retrospective study. SETTING AND PARTICIPANTS A total of 13,966 NHs from payroll-based journal (PBJ) and claim-based quality measures published by the Centers for Medicare and Medicaid Services in 2021-2022. METHODS Facilities were identified as having NH-employed NPs if at least 1 employed NP with paid working hours ≥10 per week was reported through the PBJ. We examined if having NH-employed NPs was associated with nursing staff turnover rates, unplanned hospital utilization, infection control citations, and substantiated complaints using doubly robust estimation that combined inverse probability weight representing the NH's likelihood of employing NPs and outcome regression. RESULTS Approximately, 2.8% of NHs had employed NPs. Facilities with NH-employed NPs tended to be larger, hospital affiliated, and not for profit with greater medical and nursing staff availability. In addition, a significantly higher proportion of facilities with NH-employed NPs were in metropolitan areas or states with full NP practice independence. We found that facilities with NH-employed NPs had significantly lower registered nurse (adjusted β, -5.40; 95% CI, -9.50 to -1.30) and certified nursing assistant turnover rates (adjusted β, -3.35; 95% CI, -6.29 to -0.40). Facilities with NH-employed NPs also had significantly fewer long-stay resident hospitalizations, infection control citations, and substantial complaints compared with those with no NH-employed NPs. CONCLUSIONS AND IMPLICATIONS This study highlights the value of NH-employed NPs to improve registered nurse and certified nursing assistant staff retention and NH resident outcomes. NH stakeholders and policymakers may consider various strategies to incentivize NP employment in NHs such as removing regulatory barriers to NP practice.
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Affiliation(s)
- Bo Kyum Yang
- Department of Health Sciences, Towson University, Towson, MD, USA.
| | - Shannon Idzik
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - H Wayne Nelson
- Department of Health Sciences, Towson University, Towson, MD, USA
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Meddings J, Gibbons JB, Reale BK, Banerjee M, Norton EC, Bynum JP. The Impact of Nurse Practitioner Care and Accountable Care Organization Assignment on Skilled Nursing Services and Hospital Readmissions. Med Care 2023; 61:341-348. [PMID: 36920180 PMCID: PMC10175087 DOI: 10.1097/mlr.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Accountable care organizations (ACOs) and the employment of nurse practitioners (NP) in place of physicians are strategies that aim to reduce the cost and improve the quality of routine care delivered in skilled nursing facilities (SNF). The recent expansion of ACOs and nurse practitioners into SNF settings in the United States may be associated with improved health outcomes for patients. OBJECTIVES To determine the relationship between ACO attribution and NP care delivery during SNF visits and the relationship between NP care delivery during SNF visits and unplanned hospital readmissions. METHODS We obtained a sample of 527,329 fee-for-service Medicare beneficiaries with 1 or more SNF stays between 2012 and 2017. We used logistic regression to measure the association between patient ACO attribution and evaluation and management care delivered by NPs in addition to the relationship between evaluation and management services delivered by NPs and hospital readmissions. RESULTS ACO beneficiaries were 1.26% points more likely to receive 1 or more E&M services delivered by an NP during their SNF visits [Marginal Effect (ME): 0.0126; 95% CI: (0.009, 0.0160)]. ACO-attributed beneficiaries receiving most of their E&M services from NPs during their SNF visits were at a lower risk of readmission than ACO-attributed beneficiaries receiving no NP E&M care (5.9% vs. 7.1%; P <0.001). CONCLUSIONS Greater participation by the NPs in care delivery in SNFs was associated with a reduced risk of patient readmission to hospitals. ACOs attributed beneficiaries were more likely to obtain the benefits of greater nurse practitioner involvement in their care.
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Affiliation(s)
- Jennifer Meddings
- Institute for Healthcare Policy & Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
- Department of Internal Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, USA
| | - Jason B. Gibbons
- Department of Health Policy & Management, Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205, USA
| | - Bailey K. Reale
- Department of Internal Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Mousumi Banerjee
- Institute for Healthcare Policy & Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
- Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights SPH II, Ann Arbor, MI 48109, USA
| | - Edward C. Norton
- Institute for Healthcare Policy & Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
- Department of Health Management & Policy, University of Michigan School of Public Health, 1415 Washington Heights SPH II, Ann Arbor, MI 48109, USA
- Department of Economics, University of Michigan, 611 Tappan Ave, Ann Arbor, MI 48109, USA
| | - Julie P.W. Bynum
- Institute for Healthcare Policy & Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
- Department of Internal Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
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O'Reilly-Jacob M, Perloff J, Srinivasan M, Alvarez M, Hoyt A. State Variation in the Utilization of Nurse Practitioner-Provided Home-Based Primary Care: A Medicare Claims Analysis. J Gerontol Nurs 2023; 49:11-17. [PMID: 37126015 DOI: 10.3928/00989134-20230414-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Nurse practitioners (NPs) provide an increasing proportion of home-based primary care, despite restrictive scope of practice laws in approximately one half of states. We examined the relationship between scope of practice laws and state volume of NP-provided home-based primary care by performing an analysis of 2018 to 2019 Medicare claims. For each state we calculated the proportion of total home-based primary care visits by NPs and the proportion of all NPs providing home-based primary care. We used the 2018 American Association of Nurse Practitioners classification of state practice environment. We performed chi-square tests to assess the significance between volume and practice environment. We found that 42% of home-based primary care is delivered by NPs nationally, but substantial variation exists across states. We did not find a discernible or statistically significant pattern of uptake of NP-provided home-based primary care across full, reduced, or restricted states. [Journal of Gerontological Nursing, 49(5), 11-17.].
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TYLER DENISEA, FENG ZHANLIAN, GRABOWSKI DAVIDC, BERCAW LAWREN, SEGELMAN MICAH, KHATUTSKY GALINA, WANG JOYCE, GASDASKA ANGELA, INGBER MELVINJ. CMS Initiative to Reduce Potentially Avoidable Hospitalizations Among Long-Stay Nursing Facility Residents: Lessons Learned. Milbank Q 2022; 100:1243-1278. [PMID: 36573335 PMCID: PMC9836234 DOI: 10.1111/1468-0009.12594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/20/2022] [Accepted: 07/27/2022] [Indexed: 12/28/2022] Open
Abstract
Policy Points Misaligned incentives between Medicare and Medicaid may result in avoidable hospitalizations among long-stay nursing home residents. Providing nursing homes with clinical staff, such as nurse practitioners, was more effective in reducing resident hospitalizations than providing Medicare incentive payments alone. CONTEXT In 2012, the Centers for Medicare and Medicaid Services implemented the Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. In Phase 1 (2012 to 2016), clinical or education-based interventions (Clinical-Only) aimed to reduce hospitalizations among long-stay nursing home residents. In Phase 2 (2016 to 2020), the Initiative also included a Medicare payment incentive for treating residents with certain conditions within the nursing home. Nursing homes participating in Phase 1 continued their previous interventions and received the incentive (Clinical + Payment) and others received the incentive only (Payment-Only). METHODS Mixed methods were used to determine the effectiveness of the Initiative and explore facilitators of and barriers to implementation that participating nursing homes experienced. We used telephone and in-person interviews to investigate aspects of implementation and a difference-in-differences regression model framework comparing residents in participating and nonparticipating nursing homes to determine the effect of the Initiative on measures of utilization, expenditures, and quality. FINDINGS Three key components were necessary for successful implementation of the Initiative-staff retention and leadership stability, leadership and staff support, and provider engagement and support. Nursing homes that lacked one or more of these three components experienced greater challenges. The Clinical-Only intervention in Phase 1 was successful in reducing hospitalizations. We did not find evidence that the Clinical + Payment or Payment-Only interventions were successful in reducing hospitalizations. CONCLUSIONS Reducing hospitalizations among nursing home residents hinges upon the availability and support of clinical staff who can provide ongoing education to direct-care staff in the nursing home, as well as hands-on care. Use of Medicare payment incentives alone to encourage on-site treatment of residents was insufficient to reduce hospitalizations. Unless nursing homes are adequately staffed to treat residents with acute care needs, further reductions in hospitalizations will be difficult to achieve.
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McGilton KS, Krassikova A, Wills A, Durante V, Yeung L, Vellani S, Sidani S, Escrig-Pinol A. Nurse Practitioners Navigating the Consequences of Directives, Policies, and Recommendations Related to the COVID-19 Pandemic in Long-Term Care Homes. J Appl Gerontol 2022; 41:2296-2306. [PMID: 35758019 PMCID: PMC9234378 DOI: 10.1177/07334648221110210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives New models for the workforce are required in long-term care (LTC) homes, as
was made evident during the Coronavirus Disease 2019 (COVID-19) pandemic.
Nurse Practitioner (NP)-led models of care represent an effective solution.
This study explored NPs’ roles in supporting LTC homes as changes in
directives, policies, and recommendations related to COVID-19 were
introduced. Design Qualitative exploratory study. Context Thirteen NPs working in LTC homes in Ontario, Canada. Methods Semi-structured interviews were conducted in March/April 2021. A five-step
inductive thematic analysis was applied. Findings Analysis generated four themes: leading the COVID-19 vaccine rollout;
promoting staff wellbeing related to COVID-19 fatigue; addressing
complexities of new admissions; and negotiating evolving collaborative
relationships. Conclusions Nurse practitioners were instrumental in supporting LTC homes through
COVID-19 regulatory changes producing unintended consequences. The NPs’
leadership in transforming care is equally essential in LTC homes as in
other established healthcare settings, such as primary and acute care.
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Affiliation(s)
- Katherine S McGilton
- KITE, 7961Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Alexandra Krassikova
- KITE, 7961Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aria Wills
- KITE, 7961Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Vanessa Durante
- KITE, 7961Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Lydia Yeung
- KITE, 7961Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Shirin Vellani
- KITE, 7961Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, 104269Ryerson University, Toronto, ON, Canada
| | - Astrid Escrig-Pinol
- KITE, 7961Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Mar Nursing School (ESIMar), Pompeu Fabra University, Barcelona, Spain
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The Advanced Practice Registered Nurse Leadership Role in Nursing Homes. Nurs Clin North Am 2022; 57:245-258. [PMID: 35659986 PMCID: PMC9066344 DOI: 10.1016/j.cnur.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Faraz Covelli A, Buchholz SW, Fowler LH, Beasley S, Bigley MB. Development of the Doctor of Nursing Practice Nurse Practitioner Minimum Data Set (DNP NP MDS). J Prof Nurs 2022; 39:54-68. [DOI: 10.1016/j.profnurs.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
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Ryskina KL, Song W, Sharma V, Yuan Y, Intrator O. Characterizing Physician Practice in Nursing Homes Using Claims-Based Measures: Correlation With Nursing Home Administrators' Perceptions. Med Care Res Rev 2020; 78:806-815. [PMID: 32985350 DOI: 10.1177/1077558720960900] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Heterogeneity in physician practice within nursing homes (NHs) may explain variations in quality. However, data on physician practice organization in NHs are hard to obtain. We characterized NH physician practice using two claims-based measures: (a) concentration of NH care among physicians (measured by Herfindahl-Hirschman index of visits); and (b) physician NH practice specialization (measured by the proportion of a physician's visits to NHs). We examined the relationship between the measures and NH administrator perceptions of physician practice reported in the Shaping Long-Term Care in America (SLTCA) Survey. All 2011 Part B claims from 13,718 physicians who treated Medicare fee-for-service patients in 2,095 NHs in the SLTCA survey were analyzed. The median Herfindahl-Hirschman index was 0.44 (interquartile range [IQR] 0.28-0.70), and the median specialization was 38.1% (IQR 19.9% to 60.9%). NHs with higher physician specialization reported more frequent physician participation in care coordination activities. Claims-based measures could inform the study of NH physician practice.
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Affiliation(s)
| | - Wei Song
- University of Rochester, Rochester, NY, USA.,Canandaigua VAMC, Rochester, NY, USA
| | | | - Yihao Yuan
- University of Pennsylvania, Philadelphia, PA, USA
| | - Orna Intrator
- University of Rochester, Rochester, NY, USA.,Canandaigua VAMC, Rochester, NY, USA
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Kistler CE, Beeber AS, Zimmerman S, Ward K, Farel CE, Chrzan K, Wretman CJ, Boynton MH, Pignone M, Sloane PD. Nursing Home Clinicians' Decision to Prescribe Antibiotics for a Suspected Urinary Tract Infection: Findings From a Discrete Choice Experiment. J Am Med Dir Assoc 2020; 21:675-682.e1. [PMID: 31974065 DOI: 10.1016/j.jamda.2019.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine which nursing home (NH) resident characteristics were most important to clinicians' decision to prescribe antibiotics for a suspected urinary tract infection (UTI), including both evidence-based and non-evidence-based characteristics. DESIGN Web-based discrete choice experiment with 19 clinical scenarios. For each scenario, clinicians were asked whether they would prescribe an antibiotic for a suspected UTI. SETTING Online survey. PARTICIPANTS Convenience sample of 876 NH physicians and advanced practice providers who practiced primary care for NH residents in the United States. METHODS Each scenario varied information about 10 resident characteristics regarding urinalysis results, resident temperature, lower urinary tract symptoms, physical examination, antibiotic request, mental status, UTI risk, functional status, goals of care, and resident type. We derived importance scores for the characteristics and odds ratios (ORs) for specific information related to each characteristic from a multinomial logistic regression. RESULTS Approximately half of the participants were male (56%) with a mean age of 49 years. Resident characteristics differed in their importance (ie, part-worth utility) when deciding whether to prescribe for a suspected UTI: urinalysis results (32%), body temperature (17%), lower urinary tract symptoms (17%), physical examination (15%), antibiotic request (7%), mental status (4%), UTI risk (4%), functional status (3%), goals of care (2%), and resident type (1%). Information about "positive leukocyte esterase, positive nitrates" was associated with highest odds of prescribing [OR 19.6, 95% confidence interval (CI) 16.9, 22.7], followed by "positive leukocyte esterase, negative nitrates" (OR 6.7, 95% CI 5.8, 7.6), and "painful or difficult urination" (OR 4.8, 95% CI 4.2, 5.5). CONCLUSIONS AND IMPLICATIONS Although guidelines focus on lower urinary tract symptoms, body temperature, and physical examination for diagnosing a UTI requiring antibiotics, these characteristics were considered less important than urinalysis results, which have inconsistent clinical utility in NH residents. Point-of-care clinical decision support offers an evidence-based prescribing process.
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Affiliation(s)
- Christine E Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC; The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.
| | - Anna S Beeber
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; School of Social Work, University of North Carolina, Chapel Hill, NC
| | - Kimberly Ward
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | - Claire E Farel
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Christopher J Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | | | | | - Philip D Sloane
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC; The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
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Balmer D, Frey R, Gott M, Robinson J, Boyd M. Provision of palliative and end-of-life care in New Zealand residential aged care facilities: general practitioners' perspectives. Aust J Prim Health 2020; 26:124-131. [DOI: 10.1071/py19081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/15/2019] [Indexed: 11/23/2022]
Abstract
This exploratory study examined general practitioners’ (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs’ life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility’s end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs.
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15
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Dassel KB, Flattes V, Eaton J, Towsley G, Moyers L, Edelman L. Development of a Gerontology Graduate Certificate in Post-Acute and Long-Term Care. J Gerontol Nurs 2019; 45:47-52. [PMID: 31560076 DOI: 10.3928/00989134-20190825-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022]
Abstract
Nurse practitioners (NPs) can provide safe, effective, quality care to older adults in post-acute and long-term care (PALTC) settings. However, there is a paucity of exposure to PALTC settings in most NP educational programs. Therefore, the current authors developed an elective graduate certificate in gerontology with an emphasis in PALTC for NP students. The graduate certificate curriculum was developed by faculty with expertise in nursing and gerontology education. The PALTC certificate comprises 15 credit hours of online didactic courses, 80 leadership hours, 200 clinical hours, and a scholarly project dedicated to PALTC. Completion of a graduate certificate in PALTC is a novel model for preparing NP students for practice in PALTC settings. The current article serves as a framework for other programs to reference as they develop individualized graduate certificate PALTC programs in their academic institutions. [Journal of Gerontological Nursing, 45(10), 47-52.].
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16
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A nurse practitioner-led medication reconciliation process to reduce hospital readmissions from a skilled nursing facility. J Am Assoc Nurse Pract 2019; 32:160-167. [PMID: 31397737 DOI: 10.1097/jxx.0000000000000264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Skilled nursing facilities (SNFs) are penalized for hospital readmissions within 30 days. Medication errors often precipitate hospital returns. The Centers for Medicare and Medicaid Services mandates that health care providers must determine whether medications pose significant risks and implement corrective actions. Federal restrictions exist regarding nurse practitioners (NPs) in long-term care; however, NPs are efficient in the health care of patients requiring a SNF, including completing thorough medication reconciliation and correcting deficiencies. LOCAL PROBLEM A needs assessment of a 90-bed SNF revealed inadequate medical coverage and no formalized program to reduce hospital readmissions, including a mandated medication reconciliation process. The problem contributed to an average 30-day readmission rate of 24.15%. METHODS The investigators sought to determine whether an NP-led medication reconciliation on admission would reduce hospital readmissions from a SNF. A pre- and postimplementation design was used to compare 30-day hospital readmission rates over a 30-day project period. INTERVENTIONS An evidence-based workflow process for systematic medication reconciliation was designed. A full-time NP used the workflow process to complete stabilization visits with medication reconciliation on each facility admission. RESULTS Results revealed a hospital readmission rate of 19.2% preimplementation and 13.5% postimplementation, reflecting a 29.7% decrease in the rate of hospital readmissions within a 30-day period. CONCLUSION A chi-square analysis conveyed no statistical significance; yet, the positive benefits of NP intervention included reduced hospitalizations, increased revenue, improved quality measures and survey results, and preparation for the Centers for Medicare and Medicaid Services mandates. IMPLICATIONS FOR PRACTICE Nurse practitioners have the necessary education and skills to provide quality care as well as achieving CMS mandates and improving quality measures in SNF settings.
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Lovink MH, van Vught AJAH, Persoon A, Koopmans RTCM, Laurant MGH, Schoonhoven L. Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study. Nurs Health Sci 2019; 21:282-290. [PMID: 30932288 PMCID: PMC6850111 DOI: 10.1111/nhs.12601] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 01/09/2019] [Accepted: 01/20/2019] [Indexed: 11/30/2022]
Abstract
Nursing home physicians face heavy workloads, because of the aging population and rising number of older adults with one or more chronic diseases. Skill mix change, in which professionals perform tasks previously reserved for physicians independently or under supervision, could be an answer to this challenge. The aim of this study was to describe how skill mix change in nursing homes is organized from four monodisciplinary perspectives and the interdisciplinary perspective, what influences it, and what its effects are. The study focused particularly on skill mix change through the substitution of nurse practitioners, physician assistants, or registered nurses for nursing home physicians. Five focus group interviews were conducted in the Netherlands. Variation in tasks and responsibilities was found. Despite this variation, stakeholders reported increased quality of health care, patient centeredness, and support for care teams. A clear vision on skill mix change, acceptance of nurse practitioners, physician assistants, and registered nurses, and a reduction of legal insecurity are needed that might maximize the added value of nurse practitioners, physician assistants, and registered nurses.
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Affiliation(s)
- Marleen H Lovink
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anneke J A H van Vught
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Miranda G H Laurant
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Lisette Schoonhoven
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Julius Center, Nursing Science, University Medical Center, Utrecht, the Netherlands.,Faculty of Health Sciences, University of Southampton, Southampton, UK
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18
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Ryskina KL, Lam C, Jung HY. Association Between Clinician Specialization in Nursing Home Care and Nursing Home Clinical Quality Scores. J Am Med Dir Assoc 2019; 20:1007-1012.e2. [PMID: 30745174 DOI: 10.1016/j.jamda.2018.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/24/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022]
Abstract
IMPORTANCE While the number of prescribing clinicians (physicians and nurse practitioners) who provide any nursing home care remained stable over the past decade, the number of clinicians who focus their practice exclusively on nursing home care has increased by over 30%. OBJECTIVES To measure the association between regional trends in clinician specialization in nursing home care and nursing home quality. DESIGN Retrospective cross-sectional study. SETTING AND PARTICIPANTS Patients treated in 15,636 nursing homes in 305 US hospital referral regions between 2013 and 2016. MEASURES Clinician specialization in nursing home care for 2012-2015 was measured using Medicare fee-for-service billings. Nursing home specialists were defined as generalist physicians (internal medicine, family medicine, geriatrics, and general practice) or advanced practitioners (nurse practitioners and physician assistants) with at least 90% of their billings for care in nursing homes. The number of clinicians was aggregated at the hospital referral region level and divided by the number of occupied Medicare-certified nursing home beds. Nursing Home Compare quality measure scores for 2013-2016 were aggregated at the HHR level, weighted by occupied beds in each nursing home in the hospital referral region. We measured the association between the number of nursing home specialists per 1000 beds and the clinical quality measure scores in the subsequent year using linear regression. RESULTS An increase in nursing home specialists per 1000 occupied beds in a region was associated with lower use of long-stay antipsychotic medications and indwelling bladder catheters, higher prevalence of depressive symptoms, and was not associated with urinary tract infections, use of restraints, or short-stay antipsychotic use. CONCLUSIONS AND IMPLICATIONS Higher prevalence of nursing home specialists was associated with regional improvements in 2 of 6 quality measures. Future studies should evaluate whether concentrating patient care among clinicians who specialize in nursing home practice improves outcomes for individual patients. The current findings suggest that prescribing clinicians play an important role in nursing home care quality.
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Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Christine Lam
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hye-Young Jung
- Division of Healthcare Policy and Economics, Weill Cornell Medical College, New York, NY
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19
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The future of population medicine: Investigating the role of advanced practice providers and simulation education in special patient populations. Dis Mon 2018; 65:221-244. [PMID: 30583793 DOI: 10.1016/j.disamonth.2018.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advanced practice providers (APPs) have come to play an increasingly significant role in the United States healthcare system in the past five decades, particularly in primary care. The first portion of this paper will explore the utilization of APPs in specific patient populations: pediatrics, obstetrics, geriatrics, and psychiatry. After a brief discussion of the demand for these specialties, the authors will outline the educational preparation and competencies that nurse practitioners and physician assistants must achieve before working with these special populations. Finally, the authors will discuss the current and future roles of APPs in pediatric, obstetric, geriatric, and psychiatric populations. Simulated patient interactions and scenarios have become integrated into clinical education for many health care providers. Although traditionally utilized only in emergency medicine education, medical simulation has grown to become a staple of training in nearly every area of medicine. Healthcare providers of all levels can benefit from both individual and team-based training designed to improve everything from patient communication to procedural competence. The flexible nature of simulation training allows for customized teaching that is directly relevant to a specific specialty. The second half of this paper will demonstrate simulation's versatilite applications in the specialty areas of urgent care, pediatrics, mental health, geriatrics, and obstetrics.
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20
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Privately practicing nurse practitioner services in Australia and patient access to care: Results from realist interviews. J Am Assoc Nurse Pract 2018; 30:344-353. [PMID: 29878968 DOI: 10.1097/jxx.0000000000000038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To facilitate the expansion of nurse practitioners working in community and primary health settings, legislative changes were enacted in 2010. These led to privately practicing nurse practitioners (PPNPs) being enabled to provide care subsidized through the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Little is known about the impact of this legislation on patient access to care in Australia. PURPOSE To explore how, why and in which contexts PPNP services in Australia impact on patient access to care. METHODS Semistructured interviews using realist evaluation were undertaken with 20 participants, selected through stratified sampling using geographic criteria (State/territory in which practicing) and dividing the sample representatively between those who worked solely in private practice and those who worked in both private and public practice. Thematic analysis of qualitative data was undertaken. CONCLUSION Findings suggest that PPNPs have increased access to care for patients, predominantly in community and primary health settings. IMPLICATIONS FOR PRACTICE In increasing access to care, PPNPs have the potential to reduce hospital and general practitioner attendance, thereby potentially reducing the ever-increasing demand for health care.
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21
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Lovink MH, Persoon A, van Vught AJAH, Schoonhoven L, Koopmans RTCM, Laurant MGH. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study. BMJ Open 2017; 7:e015134. [PMID: 28600370 PMCID: PMC5734255 DOI: 10.1136/bmjopen-2016-015134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/13/2017] [Accepted: 03/13/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. METHODS AND ANALYSIS This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. ETHICS AND DISSEMINATION The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government.
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Affiliation(s)
- Marleen Hermien Lovink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud university Medical Center, Radboud Institute for Health Sciences, the Netherlands
| | - Anneke JAH van Vught
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- University of Southampton, Faculty of Health Sciences, Southampton, UK
| | - Raymond TCM Koopmans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Miranda GH Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
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Xue Y, Intrator O. Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform. Policy Polit Nurs Pract 2016; 17:24-31. [PMID: 27166344 DOI: 10.1177/1527154416645539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The evolving role of nurse practitioners (NPs) as primary care providers, especially for vulnerable populations, is central to the debate regarding strategies to address the growing need for primary care services. The current article provides policy recommendations for leveraging and expanding the historic role of NPs in caring for vulnerable populations, by focusing on three key policy levers: NP scope-of-practice regulation, distribution of the NP workforce, and NP education. These policy levers must go hand in hand to build a sufficient and equitably distributed NP workforce, to help meet the escalating need for primary care in an era of health-care reform.
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Affiliation(s)
- Ying Xue
- University of Rochester School of Nursing, Rochester, NY, USA
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA Canandaigua VA Medical Center, Canandaigua, NY, USA
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Romano PS, Zinn JS. Best of the 2015 AcademyHealth Annual Research Meeting. Health Serv Res 2016; 50:1731-3. [PMID: 26768956 DOI: 10.1111/1475-6773.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Patrick S Romano
- UC Davis School of Medicine, Center for Healthcare Policy and Research, Sacramento, CA
| | - Jacqueline S Zinn
- Department of Risk, Insurance and Healthcare Management, Temple University, Philadelphia, PA
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