title: A Medicare current beneficiary survey-based investigation of alternative primary care models in nursing homes: functional ability and health status outcomes.
abstract: This study assessed how the health status and functioning of Medicare beneficiaries residing in nursing homes varies systematically with nurse practitioners (NPs) and physician assistants (PAs) providing primary care services. A secondary analysis was conducted using data from the 2006, 2007, and 2008 Medicare Current Beneficiary Surveys. The study sample included 433 participant-year observations within one of three cohorts: (a) medical doctor (MD)-only, those who received primary care services exclusively from a physician; (b) MD-dominant, those who received some primary care services from an NP or PA, but those visits accounted for less than one half of total primary care visits; and (c) NP/PA-dominant, those who received more than one half of their primary care visits from an NP or PA. Participants in the MD-only cohort had significantly less orientation and independence in activities of daily living compared to participants in the NP/PA-dominant cohort. Other study variables did not vary significantly by practice model. Although the study provides some evidence that NP/PA involvement is associated with improved functioning, it is premature to draw strong inferences.
authors: Lisa M
authors: LM
authors: Abdallah
authors: Deborah
authors: D
authors: Van Etten
authors: A James
authors: AJ
authors: Lee
authors: Karen Devereaux
authors: KD
authors: Melillo
authors: Ruth
authors: R
authors: Remington
authors: Ramraj
authors: R
authors: Gautam
authors: Rebecca J
authors: RJ
authors: Gore
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006302:Health Services Research; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017146:Models, Organizational; D009722:Nurse Practitioners / Q000458:organization & administration; D009735:Nursing Homes / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010823:Physician Assistants / Q000458:organization & administration; D010820:Physicians / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States