title: Improving primary care in nursing homes.
abstract: We conducted a quasi-experiment to evaluate the impact of a Medicare waiver which allowed the use of nurse practitioners (NPs) and physicians assistants (PAs) to deliver primary care to Massachusetts nursing home patients and removed the limits on the reimbursable numbers of visits per month. A carefully matched set of 1,327 Medicaid patients from 95 non-participating homes in the same areas of Massachusetts was compared to 1,324 Medicaid demonstration patients from 75 homes. Information came from specially designed record reviews and the Medicaid and Medicare information systems. Separate analyses were done for newly admitted cases and rollovers. Comparisons of quality of care suggested that the medical groups using NPs and PAs provided as good or better care than did the physicians in the control group. There were no differences in functional status changes or in the use of medications. The demonstration patients received more attention, as reflected in more orders written and an average of one additional visit a month. Demonstration patients showed higher scores on three of seven specially designed quality tracers, congestive heart failure and hypertension for both new administrations and rollovers, and new urinary incontinence for new admissions. Rollovers had significantly fewer emergency and total hospital days. A cost analysis suggests that the use of NPs and PAs saves at least as much as it costs and may save additional money with more sustained use.
authors.affiliation: University of Minnesota School of Public Health, Minneapolis 55455.
authors.forename: R L
authors.initials: RL
authors.lastname: Kane
authors.forename: J
authors.initials: J
authors.lastname: Garrard
authors.forename: J L
authors.initials: JL
authors.lastname: Buchanan
authors.forename: A
authors.initials: A
authors.lastname: Rosenfeld
authors.forename: C
authors.initials: C
authors.lastname: Skay
authors.forename: S
authors.initials: S
authors.lastname: McDermott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008404:Massachusetts; D016345:Medicare Part B / Q000191:economics* / Q000331:legislation & jurisprudence; D009722:Nurse Practitioners / Q000592:standards / Q000706:statistics & numerical data*; D009735:Nursing Homes; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000592:standards; D015397:Program Evaluation; D011787:Quality of Health Care; D014481:United States; D000078329:Workforce