Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
pmc-release:
01
04
2025
medline:
11
3
2024
pubmed:
1
12
2023
entrez:
30
11
2023
Statut:
ppublish
Résumé
Over 12 million Americans are dually enrolled in Medicare and Medicaid. These individuals experience over twice as many hospitalizations for chronic diseases such as coronary artery disease and diabetes compared with Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address the care needs of dually-enrolled patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and hospitalization disparities between dually-enrolled and Medicare-only patients with chronic diseases. Using secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire and Medicare claims files, we examined 135,648 patients with coronary artery disease and/or diabetes (20.0% dually-eligible, 80.0% Medicare-only), cared for in 450 practices employing NPs across 4 states (PA, NJ, CA, FL) in 2015. We compared dually-enrolled patients' odds of being hospitalized when cared for in practice environments characterized as poor, mixed, and good based on practice-level Nurse Practitioner Primary Care Organizational Climate Questionnaire scores. After adjusting for patient and practice characteristics, dually-enrolled patients in poor practice environments had the highest odds of being hospitalized compared with their Medicare-only counterparts [odds ratio (OR): 1.48, CI: 1.37, 1.60]. In mixed environments, dually-enrolled patients had 27% higher odds of a hospitalization (OR: 1.27, CI: 1.12, 1.45). However, in the best practice environments, hospitalization differences were nonsignificant (OR: 1.02, CI: 0.85, 1.23). As policymakers look to improve outcomes for dually-enrolled patients, addressing a modifiable aspect of care delivery in NPs' clinical practice environment is a key opportunity to reduce hospitalization disparities.
Sections du résumé
BACKGROUND
BACKGROUND
Over 12 million Americans are dually enrolled in Medicare and Medicaid. These individuals experience over twice as many hospitalizations for chronic diseases such as coronary artery disease and diabetes compared with Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address the care needs of dually-enrolled patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and hospitalization disparities between dually-enrolled and Medicare-only patients with chronic diseases.
METHODS
METHODS
Using secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire and Medicare claims files, we examined 135,648 patients with coronary artery disease and/or diabetes (20.0% dually-eligible, 80.0% Medicare-only), cared for in 450 practices employing NPs across 4 states (PA, NJ, CA, FL) in 2015. We compared dually-enrolled patients' odds of being hospitalized when cared for in practice environments characterized as poor, mixed, and good based on practice-level Nurse Practitioner Primary Care Organizational Climate Questionnaire scores.
RESULTS
RESULTS
After adjusting for patient and practice characteristics, dually-enrolled patients in poor practice environments had the highest odds of being hospitalized compared with their Medicare-only counterparts [odds ratio (OR): 1.48, CI: 1.37, 1.60]. In mixed environments, dually-enrolled patients had 27% higher odds of a hospitalization (OR: 1.27, CI: 1.12, 1.45). However, in the best practice environments, hospitalization differences were nonsignificant (OR: 1.02, CI: 0.85, 1.23).
CONCLUSIONS
CONCLUSIONS
As policymakers look to improve outcomes for dually-enrolled patients, addressing a modifiable aspect of care delivery in NPs' clinical practice environment is a key opportunity to reduce hospitalization disparities.
Identifiants
pubmed: 38036459
doi: 10.1097/MLR.0000000000001951
pii: 00005650-990000000-00183
pmc: PMC10949042
mid: NIHMS1937649
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
217-224Subventions
Organisme : NINR NIH HHS
ID : R01 NR014855
Pays : United States
Organisme : NINR NIH HHS
ID : T32 NR007104
Pays : United States
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
J Nurs Regul. 2022 Apr;13(1):5-12
pubmed: 36249162
J Nurs Regul. 2019 Jul;10(2):31-37
pubmed: 33833902
Health Serv Res. 2013 Dec;48(6 Pt 1):2037-59
pubmed: 23800087
Policy Polit Nurs Pract. 2017 May;18(2):84-94
pubmed: 28766986
J Nurse Pract. 2020 Apr;16(4):294-298
pubmed: 32863798
Health Aff (Millwood). 2018 Aug;37(8):1265-1273
pubmed: 30080452
Int J Nurs Stud. 2017 Sep;74:15-23
pubmed: 28595110
Med Care. 2021 Jun 1;59(6):487-494
pubmed: 33973937
Nurs Outlook. 2020 Jan - Feb;68(1):14-25
pubmed: 31477313
Am J Manag Care. 2014 Nov;20(11 Spec No. 17):eSP31-8
pubmed: 25811817
Med Care. 2018 Jun;56(6):484-490
pubmed: 29613873
Nurs Outlook. 2014 Nov-Dec;62(6):440-7
pubmed: 25172368
JAMA Health Forum. 2022 May 27;3(5):e221173
pubmed: 35977257
Med Care. 2018 Sep;56(9):791-797
pubmed: 30015724
Med Care Res Rev. 2007 Apr;64(2 Suppl):104S-22S
pubmed: 17406014
Med Care. 2022 Jul 1;60(7):496-503
pubmed: 35679173
Nurs Res. 2013 Sep-Oct;62(5):325-34
pubmed: 23995466
BMJ. 2015 Jan 20;350:h176
pubmed: 25646760
Prev Med Rep. 2018 Sep 05;12:101-105
pubmed: 30233997
JAMA Cardiol. 2021 Jul 1;6(7):791-800
pubmed: 33825802
JAMA Netw Open. 2021 Apr 1;4(4):e214925
pubmed: 33830229
Ann Intern Med. 2010 May 18;152(10):649-54
pubmed: 20479030
Environ Res. 2018 Oct;166:529-536
pubmed: 29957506
J Gen Intern Med. 2021 Feb;36(2):487-499
pubmed: 33140272
J Nurs Adm. 2013 Oct;43(10 Suppl):S11-8
pubmed: 24022077
Med Care Res Rev. 2015 Jun;72(3):359-75
pubmed: 25854959
Health Aff (Millwood). 2015 Jul;34(7):1147-55
pubmed: 26153309
J Ambul Care Manage. 2015 Apr-Jun;38(2):109-17
pubmed: 25748259
J Prof Nurs. 2013 Nov-Dec;29(6):338-49
pubmed: 24267928
Med Care. 2019 Sep;57(9):742-749
pubmed: 31274782
J Asthma. 2022 Jun;59(6):1237-1247
pubmed: 33970741