Factors associated with the use of advanced practice nurses/physician assistants in a fee-for-service nursing home practice: a comparison with primary care physicians.
The purpose of this research was to examine factors associated with the use of advanced practice nurse and physician assistant (APN/PA) visits to nursing home (NH) patients compared with those by primary care physicians (PCPs). This was a secondary analysis using Medicare claims data. General estimation equations were used to determine the odds of NH residents receiving APN/PA visits. Ordinary least squares analyses were used to examine factors associated with these visits. A total of 5,436 APN/PAs provided care to 27% of 129,812 residents and were responsible for 16% of the 1.1 million Medicare NH fee-for-service visits in 2004. APN/PAs made an average of 33 visits annually compared with PCPs (21 visits). Neuropsychiatric and acute diagnoses and patients with a long-stay status were associated with more APN/PA visits. APN/PAs provide a substantial amount of care, but regional variations occur, and Medicare regulations constrain the ability of APN/PAs to substitute for physician visits.
Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA. debra.bakerjian@ucdmc.ucd.edu
Debra
D
Bakerjian
Charlene
C
Harrington
D057179:Advanced Practice Nursing; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005161:Facility Regulation and Control; D018588:Fee-for-Service Plans; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007349:Insurance, Health, Reimbursement; D016018:Least-Squares Analysis; D008297:Male; D006278:Medicare / Q000191:economics; D009735:Nursing Homes; D010823:Physician Assistants / Q000600:supply & distribution*; D058007:Physicians, Primary Care; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care; D017009:Professional Autonomy; D014481:United States; D000078329:Workforce