Abstract
Objectives: To document the temporal trends in alternative primary care models in which physicians, nurse practitioners (NPs), or physician assistants (PAs) engaged in care provision to the elderly, and examine the role of these models in serving elders with multiple chronic conditions and those residing in rural and health professional shortage areas (HPSAs). Design: Serial cross-sectional analysis of Medicare claims data for years 2008, 2011, and 2014. Setting: Primary care outpatient setting. Participants: Medicare fee-for-service beneficiaries who had at least 1 primary care office visit in each study year. The sample size is 2 471 498. Measurements: Physician model—Medicare beneficiary’s primary care office visits in a year were conducted exclusively by physicians; shared care model—conducted by a group of professionals that included physicians and either NPs or PAs or both; NP/PA model: conducted either by NPs or PAs or both. Results: There was a decrease in the physician model (85.5% to 70.9%) and an increase in the shared care model (11.9% to 23.3%) and NP/PA model (2.7% to 5.9%) from 2008 to 2014. Compared with the physician model, the adjusted odds ratio (AOR) of receiving NP/PA care was 3.97 (95% CI 3.80-4.14) in rural and 1.26 (95% CI 1.23-1.29) in HPSAs; and the AOR of receiving shared care was 1.66 (95% CI 1.61-1.72) and 1.14 (95% CI 1.13-1.15), respectively. Beneficiaries with 3 or more chronic conditions were most likely to received shared care (AOR = 1.67, 95% CI 1.65-1.70). Conclusion: The increase in shared care practice signifies a shift toward bolstering capacity of the primary care delivery system to serve elderly populations with growing chronic disease burden and to improve access to care in rural and HPSAs.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 256-263 |
| Number of pages | 8 |
| Journal | Journal of Primary Care and Community Health |
| Volume | 8 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 1 2017 |
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Keywords
- Access to care
- Multiple chronic conditions
- Nurse practitioners
- Physician assistants
- Primary care
ASJC Scopus subject areas
- Community and Home Care
- Public Health, Environmental and Occupational Health
Cite this
Trends in primary care provision to medicare beneficiaries by physicians, nurse practitioners, or physician assistants : 2008-2014. / Xue, Ying; Goodwin, James; Adhikari, Deepak; Raji, Mukaila; Kuo, Yong Fang.
In: Journal of Primary Care and Community Health, Vol. 8, No. 4, 01.10.2017, p. 256-263.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Trends in primary care provision to medicare beneficiaries by physicians, nurse practitioners, or physician assistants
T2 - 2008-2014
AU - Xue, Ying
AU - Goodwin, James
AU - Adhikari, Deepak
AU - Raji, Mukaila
AU - Kuo, Yong Fang
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Objectives: To document the temporal trends in alternative primary care models in which physicians, nurse practitioners (NPs), or physician assistants (PAs) engaged in care provision to the elderly, and examine the role of these models in serving elders with multiple chronic conditions and those residing in rural and health professional shortage areas (HPSAs). Design: Serial cross-sectional analysis of Medicare claims data for years 2008, 2011, and 2014. Setting: Primary care outpatient setting. Participants: Medicare fee-for-service beneficiaries who had at least 1 primary care office visit in each study year. The sample size is 2 471 498. Measurements: Physician model—Medicare beneficiary’s primary care office visits in a year were conducted exclusively by physicians; shared care model—conducted by a group of professionals that included physicians and either NPs or PAs or both; NP/PA model: conducted either by NPs or PAs or both. Results: There was a decrease in the physician model (85.5% to 70.9%) and an increase in the shared care model (11.9% to 23.3%) and NP/PA model (2.7% to 5.9%) from 2008 to 2014. Compared with the physician model, the adjusted odds ratio (AOR) of receiving NP/PA care was 3.97 (95% CI 3.80-4.14) in rural and 1.26 (95% CI 1.23-1.29) in HPSAs; and the AOR of receiving shared care was 1.66 (95% CI 1.61-1.72) and 1.14 (95% CI 1.13-1.15), respectively. Beneficiaries with 3 or more chronic conditions were most likely to received shared care (AOR = 1.67, 95% CI 1.65-1.70). Conclusion: The increase in shared care practice signifies a shift toward bolstering capacity of the primary care delivery system to serve elderly populations with growing chronic disease burden and to improve access to care in rural and HPSAs.
AB - Objectives: To document the temporal trends in alternative primary care models in which physicians, nurse practitioners (NPs), or physician assistants (PAs) engaged in care provision to the elderly, and examine the role of these models in serving elders with multiple chronic conditions and those residing in rural and health professional shortage areas (HPSAs). Design: Serial cross-sectional analysis of Medicare claims data for years 2008, 2011, and 2014. Setting: Primary care outpatient setting. Participants: Medicare fee-for-service beneficiaries who had at least 1 primary care office visit in each study year. The sample size is 2 471 498. Measurements: Physician model—Medicare beneficiary’s primary care office visits in a year were conducted exclusively by physicians; shared care model—conducted by a group of professionals that included physicians and either NPs or PAs or both; NP/PA model: conducted either by NPs or PAs or both. Results: There was a decrease in the physician model (85.5% to 70.9%) and an increase in the shared care model (11.9% to 23.3%) and NP/PA model (2.7% to 5.9%) from 2008 to 2014. Compared with the physician model, the adjusted odds ratio (AOR) of receiving NP/PA care was 3.97 (95% CI 3.80-4.14) in rural and 1.26 (95% CI 1.23-1.29) in HPSAs; and the AOR of receiving shared care was 1.66 (95% CI 1.61-1.72) and 1.14 (95% CI 1.13-1.15), respectively. Beneficiaries with 3 or more chronic conditions were most likely to received shared care (AOR = 1.67, 95% CI 1.65-1.70). Conclusion: The increase in shared care practice signifies a shift toward bolstering capacity of the primary care delivery system to serve elderly populations with growing chronic disease burden and to improve access to care in rural and HPSAs.
KW - Access to care
KW - Multiple chronic conditions
KW - Nurse practitioners
KW - Physician assistants
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=85041757390&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041757390&partnerID=8YFLogxK
U2 - 10.1177/2150131917736634
DO - 10.1177/2150131917736634
M3 - Article
VL - 8
SP - 256
EP - 263
JO - Journal of primary care & community health
JF - Journal of primary care & community health
SN - 2150-1319
IS - 4
ER -