Acute Care Use Among Patients With Multiple Chronic Conditions Receiving Care From Nurse Practitioner Practices in Health Professional Shortage Areas.
Amy McMenamin, Eleanor Turi, Justinna Dixon and 3 others
PMID 38989998WHAT IT FOUND
Older adults with multiple chronic conditions receiving care in nurse practitioner practices in shortage areas had an 8% higher likelihood of emergency department visits than those in non-shortage areas.
This difference remained after adjusting for patient demographics, socioeconomic status, and practice capabilities. Hospitalization rates showed no significant difference after adjustment.
Key findings
01Patients in Health Professional Shortage Areas (HPSA) had an 8% higher adjusted likelihood of ED visits compared to non-HPSA patients.
02Adjusted analysis showed no significant difference in hospitalization likelihood between HPSA and non-HPSA patients.
03Unadjusted analysis showed higher likelihoods for both ED visits and hospitalizations in HPSA practices.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study only included practices that employed nurse practitioners, so findings may not apply to practices without NPs. The NP survey had a low response rate of 25.4%, and respondents differed from non-respondents, potentially biasing the sample. Patients who received no primary care in HPSAs were not included, so the study may underestimate the true impact of shortages on acute care use. The analysis was limited to Medicare beneficiaries aged 65 and older with multiple chronic conditions.
Declared interests
The authors reported no conflicts of interest. The study was funded by the National Institute of Minority Health and Disparities.
The easy way to misread this
Do not conclude that nurse practitioner practices in shortage areas provide inferior care or have worse outcomes across the board. The study found no significant difference in hospitalization rates after adjustment, and the increased ED use may reflect systemic access barriers in shortage areas rather than deficiencies in the clinical care delivered by the practice.