Maximilian J. Pany (
Lucy Chen is an MD-PhD candidate in health policy at Harvard Medical School. Chen and Maximilian Pany are co-first authors.
Health Aff (Millwood). 2021 Mar;40(3):435-444. doi: 10.1377/hlthaff.2020.01580.
Scope-of-practice regulations, including prescribing limits and supervision requirements, may influence the propensity of providers to form care teams. Therefore, policy makers need to understand the effect of both team-based care and provider type on clinical outcomes. We examined how care management and biomarker outcomes after the onset of three chronic diseases differed both by team-based versus solo care and by physician versus nonphysician (that is, nurse practitioner and physician assistant) care. Using 2013-18 deidentified electronic health record data from US primary care practices, we found that provider teams outperformed solo providers, irrespective of team composition. Among solo providers, physicians and nonphysicians exhibited little meaningful difference in performance. As policy makers contemplate scope-of-practice changes, they should consider the effects of not only provider type but also team-based care on outcomes. Interventions that may encourage provider team formation, including scope-of-practice reforms, may improve the value of care.
执业范围的规定,包括处方限制和监督要求,可能会影响提供者组建医疗团队的倾向。因此,政策制定者需要了解团队式护理和提供者类型对临床结果的影响。我们研究了在三种慢性病发作后,护理管理和生物标志物结果在团队护理与单人护理以及医生与非医生(即护士从业者和医师助理)护理之间的差异。我们使用了来自美国初级保健机构 2013-18 年的去识别电子健康记录数据,发现无论团队组成如何,提供者团队的表现都优于单人提供者。在单人提供者中,医生和非医生的表现几乎没有明显差异。随着政策制定者考虑执业范围的变化,他们不仅应考虑提供者类型的影响,还应考虑团队式护理对结果的影响。可能鼓励提供者团队形成的干预措施,包括执业范围改革,可能会提高护理的价值。