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Improving primary care in nursing homes.

R L Kane1, J Garrard, J L Buchanan

  • 1University of Minnesota School of Public Health, Minneapolis 55455.

Journal of the American Geriatrics Society
|April 1, 1991
PubMed
Summary
This summary is machine-generated.

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Nurse practitioners (NPs) and physician assistants (PAs) provided comparable or better primary care in nursing homes. This Medicare waiver initiative improved quality metrics and reduced hospitalizations, proving cost-effective.

Area of Science:

  • Gerontology
  • Health Services Research
  • Primary Care Medicine

Background:

  • Medicare waivers can influence healthcare delivery models.
  • Nursing home primary care traditionally relies on physicians.
  • Evaluating advanced practice providers' roles is crucial for elder care.

Purpose of the Study:

  • To assess the impact of a Medicare waiver enabling nurse practitioners (NPs) and physician assistants (PAs) in Massachusetts nursing home primary care.
  • To compare care quality, patient outcomes, and costs between NP/PA-led and physician-led care models.

Main Methods:

  • Quasi-experimental design comparing demonstration patients (NPs/PAs) with matched control patients (physicians).
  • Utilized data from record reviews and Medicaid/Medicare information systems.

Related Experiment Videos

  • Analyzed outcomes for newly admitted and existing (rollover) patients separately.

    • Main Results:

    • NP/PA groups provided comparable or superior care quality compared to physicians.
    • No significant differences in functional status or medication use.
    • Demonstration patients received more frequent visits and attention.
    • Improved quality tracer scores for heart failure, hypertension, and incontinence.
    • Rollover patients in the demonstration group had fewer hospital days.

    Conclusions:

    • NPs and PAs can effectively deliver primary care in nursing homes under a Medicare waiver.
    • The model shows potential for improved quality of care and reduced hospitalizations.
    • Cost analysis indicates the NP/PA model is cost-neutral or cost-saving.