Brom Heather, Poghosyan Lusine, Nikpour Jacqueline, Todd Barbara, Sliwinski Kathy, Franz Tresa, Chittams Jesse, Aiken Linda, Brooks Carthon Margo
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia.
Columbia University School of Nursing, New York, New York.
J Nurs Regul. 2023 Oct;14(3):20-32. doi: 10.1016/s2155-8256(23)00110-2. Epub 2023 Sep 29.
Coronary artery disease (CAD) is the most prevalent heart disease in the United States, and it disproportionately affects Black compared to White patients. Regular primary care and dyslipidemia screening and management are essential for optimal CAD care. Nurse practitioners (NPs) increasingly provide primary care services, though unsupportive practice environments may constrain their ability to do so.
To examine whether disparities in lipid screening between Black and White patients with CAD were associated with the NP practice environment scores.
Cross-sectional survey data from NPs in primary care practices and Medicare claims were linked to evaluate outcomes among 111,911 CAD patients (94% White, 6% Black) across 456 primary care practices in four states (California, Florida, New Jersey, and Pennsylvania) in 2016. The NP-Primary Care Organizational Climate Questionnaire, which provides a score on the supportiveness of a respondent's practice, was used to evaluate the NP practice environment. Multilevel regression models that accounted for patient and practice characteristics were used to evaluate the study aim.
Compared to White patients with CAD, Black patients with CAD less frequently received annual lipid screening (77.0% vs. 70.6%; < .001). In logistic regression models accounting for patient and practice characteristics, for every standard deviation increase in the practice environment score, Black patients experienced a 5% increase in odds of receiving lipid screening.
Investing in the NP practice environment, including increasing NP role visibility and strengthening relationships with physicians and administrators, may narrow racial disparities in CAD management.
冠状动脉疾病（CAD）是美国最常见的心脏病，与白人患者相比，黑人患者受其影响的比例更高。定期进行初级保健以及血脂异常筛查和管理对于优化CAD治疗至关重要。执业护士（NP）越来越多地提供初级保健服务，尽管不支持的执业环境可能会限制他们这样做的能力。
研究CAD黑人患者和白人患者在血脂筛查方面的差异是否与NP执业环境得分相关。
将来自初级保健机构中NP的横断面调查数据与医疗保险理赔数据相链接，以评估2016年四个州（加利福尼亚州、佛罗里达州、新泽西州和宾夕法尼亚州）456家初级保健机构中111,911名CAD患者（94%为白人，6%为黑人）的治疗结果。使用NP初级保健组织气候问卷来评估NP执业环境，该问卷会给出受访者执业支持度的得分。采用考虑了患者和机构特征的多水平回归模型来评估研究目的。
与CAD白人患者相比，CAD黑人患者接受年度血脂筛查的频率较低（77.0%对70.6%；P<0.001）。在考虑了患者和机构特征的逻辑回归模型中，执业环境得分每增加一个标准差，黑人患者接受血脂筛查的几率就会增加5%。
对NP执业环境进行投入，包括提高NP的角色可见度以及加强与医生和管理人员的关系，可能会缩小CAD管理中的种族差异。
