Allison A Norful1, Krystyna de Jacq2, Jianfang Liu1, Siqin Ye3, Simran Khadka4, Lusine Poghosyan1. 1. Office of Scholarship and Research, Columbia University School of Nursing, New York City, New York. 2. Pace University College of Health Professions, New York City, New York. 3. Department of Medicine, Columbia University Medical Center, New York City, New York. 4. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York.
Abstract
BACKGROUND: New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. PURPOSE: To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. METHODS: A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition-related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. RESULTS: As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p = .007; β = -2.218; 95% confidence interval [CI]: -3.79 to -0.644 and p = .04; β = -2.698; 95% CI: -5.268 to -0.127, respectively). IMPLICATIONS FOR PRACTICE: Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries.
BACKGROUND: New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. PURPOSE: To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. METHODS: A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition-related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. RESULTS: As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p = .007; β = -2.218; 95% confidence interval [CI]: -3.79 to -0.644 and p = .04; β = -2.698; 95% CI: -5.268 to -0.127, respectively). IMPLICATIONS FOR PRACTICE: Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries.
Authors: Catherine M DesRoches; Sean Clarke; Jennifer Perloff; Monica O'Reilly-Jacob; Peter Buerhaus Journal: Nurs Outlook Date: 2017-06-15 Impact factor: 3.250
Authors: Robert E Burke; Emily A Whitfield; David Hittle; Sung-joon Min; Cari Levy; Allan V Prochazka; Eric A Coleman; Robert Schwartz; Adit A Ginde Journal: J Am Med Dir Assoc Date: 2015-12-20 Impact factor: 4.669
Authors: Melanie Swan; Sacha Ferguson; Alice Chang; Elaine Larson; Arlene Smaldone Journal: Int J Qual Health Care Date: 2015-08-03 Impact factor: 2.038
Authors: Hannah F Xu; Robert S White; Dahniel L Sastow; Michael H Andreae; Licia K Gaber-Baylis; Zachary A Turnbull Journal: J Clin Anesth Date: 2017-09-30 Impact factor: 9.452