Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
College of Nursing, The University of Tennessee Knoxville, Knoxville, Tennessee.
J Am Geriatr Soc. 2017 Apr;65(4):847-852. doi: 10.1111/jgs.14698. Epub 2016 Dec 28.
Residence-based primary care provides homebound frail patients with a care plan that is individually tailored to manage multiple chronic conditions and functional limitations using a variety of resources. We (1) examine the visit volume and Medicare payments for residence-based health care provided by nurse practitioners (NPs) in the Medicare fee-for-service environment; (2) compare NP's residential visits to those of internists and family physicians; and (3) compare the geographical service area of full-time house call NPs versus NPs who make nursing facility visits a major portion of their work.
An observational study using secondary data.
Medicare Provider Utilization and Payment Data.
Medicare beneficiaries.
Medicare payments for home and domiciliary care visits, the number of residence-based medical visits, provider volume, geographical distribution of full-time house call providers.
About 3,300 NPs performed over 1.1 million home and domiciliary care visits in 2013, accounting for 22% of all residential visits to Medicare fee-for-service beneficiaries. A total of 310 NPs individually made more than 1,000 residential visits (defined as a full-time house call provider); among full-time house call providers, including physicians, NPs are now the most common provider type. There are substantial variations in the geographic distribution of full-time house call NPs, internists, and family physicians. Full time NP's service area is about 30% larger than family physicians and internists. Nursing home residents are far more likely to receive NP visits than are homebound persons receiving home visits.
NPs are now the largest type of provider delivering residence-based care and NPs provide care over the largest geographical service area. However, the vast majority of frail Americans are more likely to receive NP's care in a nursing facility versus at home.
基于住所的初级保健为行动不便的体弱患者提供了一种护理计划，该计划根据个人情况量身定制，使用各种资源来管理多种慢性疾病和功能限制。我们（1）检查在医疗保险按服务收费环境中，执业护士（NP）提供的基于住所的医疗保健的就诊量和医疗保险支付情况；（2）比较 NP 的住院访问与内科医生和家庭医生的访问；（3）比较全职上门访问 NP 与将疗养院访问作为其工作主要部分的 NP 的地理服务区域。
使用二次数据的观察性研究。
医疗保险提供者使用和支付数据。
医疗保险受益人。
家庭和家庭护理就诊的医疗保险支付，基于住所的医疗就诊次数，提供者数量，全职上门提供者的地理分布。
大约 3300 名 NP 在 2013 年进行了超过 110 万次家庭和家庭护理就诊，占所有向医疗保险按服务收费受益人的住所就诊的 22%。共有 310 名 NP 单独进行了 1000 多次住所就诊（定义为全职上门提供者）；在全职上门提供者中，包括医生在内，NP 现在是最常见的提供者类型。全职上门 NP、内科医生和家庭医生的地理分布存在很大差异。全职 NP 的服务区域比家庭医生和内科医生大约大 30%。疗养院居民接受 NP 访问的可能性远远大于接受上门访问的居家行动不便者。
NP 现在是提供住所护理的最大类型的提供者，并且 NP 提供的服务区域最大。然而，绝大多数体弱的美国人更有可能在疗养院而不是在家里接受 NP 的护理。
