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. 2020 Oct;58(10):853-860.
doi: 10.1097/MLR.0000000000001364.

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

Taressa K Fraze  1   2   3 , Adam D M Briggs  1   4   5 , Elizabeth K Whitcomb  1 , Kristen A Peck  1   6 , Ellen Meara  7   8
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Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

Taressa K Fraze et al. Med Care. 2020 Oct.

Abstract

Objective: The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics.

Design: An observational study of 2012-2017 Medicare fee-for-service beneficiaries' ambulatory visits. We computed the percentage of beneficiaries with 1 or more ambulatory visits from nurse practitioners and the percentage of beneficiaries receiving the plurality of their ambulatory visits from a nurse practitioner versus a physician (ie, predominant provider). We compared beneficiary demographics, clinical characteristics, and utilization by the predominant provider. We then characterized the predominant provider by practice characteristics.

Key results: In 2017, 28.9% of beneficiaries received any care from a nurse practitioner and 8.0% utilized nurse practitioners as their predominant provider-an increase from 4.4% in 2012. Among beneficiaries cared for by nurse practitioners in 2017, 25.9% had 3 or more chronic conditions compared with 20.8% of those cared for by physicians. Beneficiaries cared for in practices owned by health systems were more likely to have a nurse practitioner as their predominant provider compared with those attending practices that were independently owned (9.3% vs. 7.0%).

Conclusions: Nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Percentage of ambulatory care provided by nurse practitioners to Medicare beneficiaries from 2012 to 2017.
FIGURE 2
FIGURE 2
Percentage of beneficiaries receiving the plurality of their ambulatory care from nurse practitioners compared with physicians, by complexity, in 2017.
FIGURE 3
FIGURE 3
Ambulatory care visits for beneficiaries who get the plurality of their care from nurse practitioners versus physicians, by complexity, in 2017.
FIGURE 4
FIGURE 4
Percentage of beneficiaries who get the plurality of their care from nurse practitioners by practice characteristics in 2017.
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References

    1. The Institute of Medicine (IOM), Yong PL, Saunders RS, Olsen L, The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press; 2010. - PubMed
    1. Rich E, Lipson D, Libersky J, et al. Coordinating Care for Adults With Complex Care Needs in the Patient-Centered Medical Home: Challenges and Solutions. Rockville, MD: AHRQ Publication No. 12-0010-EF; 2012.
    1. Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition—multimorbidity. JAMA. 2012;307:2493–2494. - PMC - PubMed
    1. Bodenheimer T, Chen E, Bennett HD. Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job? Health Aff (Millwood). 2009;28:64–74. - PubMed
    1. Parekh AK, Goodman RA, Gordon C, et al. Interagency Workgroup on Multiple Chronic Conditions. Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Rep. 2011;126:460–471. - PMC - PubMed

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