Institute for Health care Policy & Innovation, University of Michigan.
Department of Internal Medicine, University of Michigan Medical School.
Med Care. 2023 Jun 1;61(6):341-348. doi: 10.1097/MLR.0000000000001826. Epub 2023 Mar 15.
Accountable care organizations (ACOs) and the employment of nurse practitioners (NP) in place of physicians are strategies that aim to reduce the cost and improve the quality of routine care delivered in skilled nursing facilities (SNF). The recent expansion of ACOs and nurse practitioners into SNF settings in the United States may be associated with improved health outcomes for patients.
To determine the relationship between ACO attribution and NP care delivery during SNF visits and the relationship between NP care delivery during SNF visits and unplanned hospital readmissions.
We obtained a sample of 527,329 fee-for-service Medicare beneficiaries with 1 or more SNF stays between 2012 and 2017. We used logistic regression to measure the association between patient ACO attribution and evaluation and management care delivered by NPs in addition to the relationship between evaluation and management services delivered by NPs and hospital readmissions.
ACO beneficiaries were 1.26% points more likely to receive 1 or more E&M services delivered by an NP during their SNF visits [Marginal Effect (ME): 0.0126; 95% CI: (0.009, 0.0160)]. ACO-attributed beneficiaries receiving most of their E&M services from NPs during their SNF visits were at a lower risk of readmission than ACO-attributed beneficiaries receiving no NP E&M care (5.9% vs. 7.1%; P <0.001).
Greater participation by the NPs in care delivery in SNFs was associated with a reduced risk of patient readmission to hospitals. ACOs attributed beneficiaries were more likely to obtain the benefits of greater nurse practitioner involvement in their care.
责任医疗组织（ACO）和在熟练护理机构（SNF）中使用执业护士（NP）替代医生，是旨在降低成本并提高常规护理质量的策略。美国最近扩大了 ACO 和 NP 在 SNF 中的使用，这可能与患者的健康结果改善有关。
确定 ACO 归属与 SNF 就诊期间 NP 护理提供之间的关系，以及 SNF 就诊期间 NP 护理提供与非计划性住院再入院之间的关系。
我们获取了 2012 年至 2017 年期间有 1 次或多次 SNF 入住的 527329 名医疗保险付费服务受益人的样本。我们使用逻辑回归来衡量患者 ACO 归属与 NP 在 SNF 就诊期间提供的评估和管理护理之间的关系，以及 NP 提供的评估和管理服务与医院再入院之间的关系。
ACO 受益人的 SNF 就诊期间接受 1 次或多次 NP 提供的 E&M 服务的可能性高 1.26%（边际效应[ME]：0.0126；95%置信区间：[0.009，0.0160]）。在 SNF 就诊期间，接受大部分 E&M 服务的 ACO 受益人的再入院风险低于未接受 NP E&M 护理的 ACO 受益人的再入院风险（5.9%比 7.1%；P<0.001）。
在 SNF 中，执业护士更多地参与护理提供与患者住院再入院风险降低相关。被 ACO 归属的受益人的护理中更有可能受益于执业护士更多地参与。
