title: A new model for nurse practitioner utilization in primary care: increased efficiency and implications.
abstract: BACKGROUND
  Nurse practitioners (NPs) play an important role in providing quality primary care. However, little is known about organizational processes that best utilize NPs in care delivery and what kind of resources and support NPs need to deliver quality care within their organizations. In primary care settings, NPs often receive little support from ancillary personnel compared with physicians.
  
  
  OBJECTIVE
  The aim of this article was to compare the productivity and cost efficiency of NP utilization models implemented in primary care sites with and without medical assistant (MA) support.
  
  
  METHODS
  We develop queueing models for these NP utilization models, of which the parameters are extracted from literature or government reports. Appropriate analyses are conducted to generate formulas and values for the productivity and cost efficiency. Sensitivity analyses are conducted to investigate different scenarios and to verify the robustness of findings.
  
  
  RESULTS
  The productivity and cost efficiency of these models improve significantly if NPs have access to MA support in serving patients. On the basis of the model parameters we use, the average cost of serving a patient can be reduced by 9%-12% if MAs are hired to support NPs. Such improvements are robust across practice environments with different variability in provider service times. Improving provider service rate is a much more effective strategy to increase productivity compared with reducing the variability in provider service times.
  
  
  CONCLUSIONS
  To contain costs and improve the utilization of NPs in primary care settings, MA assistance for NPs is necessary.
authors.affiliation: Nan Liu, PhD, is Assistant Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York. E-mail: nl2320@columbia.edu. Stacey R. Finkelstein, PhD, is Assistant Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York. E-mail: sf2559@columbia.edu. Lusine Poghosyan, PhD, MPH, RN, is Assistant Professor, Columbia University School of Nursing, New York. E-mail: lp2475@columbia.edu.
authors.forename: Nan
authors.initials: N
authors.lastname: Liu
authors.forename: Stacey R
authors.initials: SR
authors.lastname: Finkelstein
authors.forename: Lusine
authors.initials: L
authors.lastname: Poghosyan
mesh_terms: D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D006801:Humans; D017146:Models, Organizational; D009722:Nurse Practitioners / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D000078329:Workforce