Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Massachusetts Health Policy Commission, Boston, MA, USA.
BMJ. 2023 Sep 14;382:e073933. doi: 10.1136/bmj-2022-073933.
To examine the proportion of healthcare visits are delivered by nurse practitioners and physician assistants versus physicians and how this has changed over time and by clinical setting, diagnosis, and patient demographics.
Cross-sectional time series study.
National data from the traditional Medicare insurance program in the USA.
Of people using Medicare (ie, those older than 65 years, permanently disabled, and people with end stage renal disease), a 20% random sample was taken.
The proportion of physician, nurse practitioner, and physician assistant visits in the outpatient and skilled nursing facility settings delivered by physicians, nurse practitioners, and physician assistants, and how this proportion varies by type of visit and diagnosis.
From 1 January 2013 to 31 December 2019, 276 million visits were included in the sample. The proportion of all visits delivered by nurse practitioners and physician assistants in a year increased from 14.0% (95% confidence interval 14.0% to 14.0%) to 25.6% (25.6% to 25.6%). In 2019, the proportion of visits delivered by a nurse practitioner or physician assistant varied across conditions, ranging from 13.2% for eye disorders and 20.4% for hypertension to 36.7% for anxiety disorders and 41.5% for respiratory infections. Among all patients with at least one visit in 2019, 41.9% had one or more nurse practitioner or physician assistant visits. Compared with patients who had no visits from a nurse practitioner or physician assistant, the likelihood of receiving any care was greatest among patients who were lower income (2.9% greater), rural residents (19.7%), and disabled (5.6%).
The proportion of visits delivered by nurse practitioners and physician assistants in the USA is increasing rapidly and now accounts for a quarter of all healthcare visits.
调查由护士从业者和医师助理提供的医疗就诊比例，以及该比例如何随时间变化以及随临床环境、诊断和患者人口统计学特征而变化。
横断面时间序列研究。
美国传统医疗保险计划的全国数据。
使用医疗保险的人群（即年龄大于 65 岁、永久残疾和终末期肾病患者）中抽取了 20%的随机样本。
医生、护士从业者和医师助理在门诊和熟练护理机构提供的医生、护士从业者和医师助理就诊比例，以及该比例如何因就诊类型和诊断而变化。
从 2013 年 1 月 1 日至 2019 年 12 月 31 日，样本中包括 2.76 亿次就诊。一年内由护士从业者和医师助理提供的所有就诊比例从 14.0%（95%置信区间 14.0%至 14.0%）增加到 25.6%（25.6%至 25.6%）。2019 年，由护士从业者或医师助理提供的就诊比例因病情而异，范围从眼部疾病的 13.2%和高血压的 20.4%到焦虑症的 36.7%和呼吸道感染的 41.5%。在所有 2019 年至少有一次就诊的患者中，41.9%的患者有一次或多次护士从业者或医师助理就诊。与没有护士从业者或医师助理就诊的患者相比，收入较低（高 2.9%）、农村居民（高 19.7%）和残疾（高 5.6%）的患者接受任何护理的可能性最大。
美国由护士从业者和医师助理提供的就诊比例正在迅速增加，目前占所有医疗就诊的四分之一。
