The Impact of the New York Nurse Practitioner Modernization Act on the Employment of Nurse Practitioners in Primary Care.

Expanding scope of practice (SOP) for nurse practitioners (NPs) may increase NP employment in primary care practices which can help meet the growing demand in primary care. We examined the impact of enacting less restrictive NP practice restrictions-NP Modernization Act-in New York State (NYS) on the overall employment of primary care NPs and specifically in underserved areas. We used longitudinal data from the SK&A outpatient database (2012-2018) to identify primary care practices in NYS and in the comparison states (Pennsylvania [PA] and New Jersey [NJ]).

Relationship between rural hospital closures and the supply of nurse practitioners and certified registered nurse anesthetists.

Background: Reductions in primary care and specialist physicians follow rural hospital closures. As the supply of physicians declines, rural healthcare systems increasingly rely on nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs) to deliver care.

Purpose: We sought to examine the extent to which rural hospital closures are associated with changes in the NP and CRNA workforce.

Differences in the number of services provided by nurse practitioners and physicians during primary care visits.

Background: Due to differential training, nurse practitioners (NPs) and physicians may provide different quantities of services to patients.

Purpose: To assess differences in the number of laboratory, imagining, and procedural services provided by primary care NPs and physicians.

Methods: Secondary analysis of 2012-2016 National Ambulatory Medical Care Survey (NAMCS), containing 308 NP-only and 73,099 physician-only patient visits, using multivariable regression and propensity score techniques.

Provider Interventions to Increase Uptake of Evidence-Based Treatment for Depression: A Systematic Review.

The objective of this systematic review was to synthesize the effectiveness of health care provider interventions that aim to increase the uptake of evidence-based treatment of depression in routine clinical practice. This study summarizes results of comprehensive searches in the quality improvement, implementation science, and behavior change literature. Studies evaluated diverse provider interventions such as sending out depression guidelines to providers, education and training such as academic detailing, and combinations of education with other components such as targeting implementation barriers.

Practice Expenses Associated with Comprehensive Primary Care Capabilities.

Through the Comprehensive Primary Care (CPC) and Comprehensive Primary Care Plus (CPC+) programs, the Centers for Medicare & Medicaid Services (CMS) has encouraged primary care practices to invest in "comprehensive primary care" capabilities. Empirical evidence suggests these capabilities are under-reimbursed or not reimbursed under prevailing fee-for-service payment models. To help CMS design alternative payment models (APMs) that reimburse the costs of these capabilities, the authors developed a method for estimating related practice expenses.

The Surgical and Anesthesia Workforce and Provision of Surgical Services in Rural Communities: A Mixed-Methods Examination.

Purpose: Rural-urban disparities in the surgical and anesthesia workforce exist. This mixed-methods study describes the distribution of the surgical and anesthesia workforce and qualitatively explores how such workforce and other factors influence rural hospitals' provision of surgical services.

Methods: We calculated provider counts by county from the Area Health Resource File.

Work Performance Among Informal Caregivers: A Review of the Literature.

To examine the association between informal caregiving and caregiver work performance. A systematized review of the literature. We found that caregiving has an adverse impact on work performance: caregivers experience substantial work disruptions and negative work performance outcomes, and these findings were consistent across measures.

When Rural Hospitals Close, The Physician Workforce Goes.

Rates of rural hospital closures have been increasing over the past decade. Closures will almost certainly restrict rural residents' access to important inpatient services, and they could also be related in important ways to the supply of physicians in the local health care system. We used data from the Area Health Resources Files for the period 1997-2016 to examine the relationship between rural hospital closures and the supply of physicians across different specialties in the years leading up to and after a closure.

Nurse Practitioner Scope of Practice Regulations and Nurse Practitioner Supply.

Adopting full scope of practice (SOP) for nurse practitioners (NPs) is associated with improved access to care. One possible mechanism for these improvements is increased NP supply. Using county-level data, we fit cross-sectional and panel regression models to estimate the association between adopting full NP SOP and NP supply in general, and in rural and health professional shortage area-designated counties in particular.

Estimating the Costs of Implementing Comprehensive Primary Care: A Narrative Review.

The performance of the any health-care system relies on a high-functioning primary care system. Increasing primary care practices' adoption of "comprehensive primary care" capabilities might yield meaningful improvements in the quality and efficiency of primary care. However, many comprehensive primary care capabilities, such as care management and coordination, are not compensated via traditional fee-for-service payment.

Elusive search for effective provider interventions: a systematic review of provider interventions to increase adherence to evidence-based treatment for depression.

Background: Depression is a common mental health disorder for which clinical practice guidelines have been developed. Prior systematic reviews have identified complex organizational interventions, such as collaborative care, as effective for guideline implementation; yet, many healthcare delivery organizations are interested in less resource-intensive methods to increase provider adherence to guidelines and guideline-concordant practices. The objective of this systematic review was to assess the effectiveness of healthcare provider interventions that aim to increase adherence to evidence-based treatment of depression in routine clinical practice.

Estimating Associations Between Medical Home Adoption, Utilization, and Quality: A Comparison of Evaluation Approaches.

Background: Methodological differences between evaluations of medical home adoption might complicate readers' ability to draw conclusions across studies.

Objectives: To study whether associations between medical home adoption and patient care are affected by methodological choices.

Design, Setting, And Subjects: Among 71 practices participating in the Pennsylvania Chronic Care Initiative (a medical home pilot), we estimated cross-sectional and longitudinal associations between 4 definitions of "medical home adoption" [National Committee on Quality Assurance (NCQA) recognition in year 3, Medical Home Index scores at baseline and 3, and within-practice changes in Medical Home Index scores between baseline and year 3] and utilization and quality.

Evaluation of Policy Options for Increasing the Availability of Primary Care Services in Rural Washington State.

The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs).

Introducing Value-Based Purchasing into TRICARE Reform.

TRICARE, the health benefits program created for beneficiaries of the U.S. Department of Defense, covers health care provided in military treatment facilities and by civilian providers.

Efficacy of mindfulness meditation for smoking cessation: A systematic review and meta-analysis.

Background: Smokers increasingly seek alternative interventions to assist in cessation or reduction efforts. Mindfulness meditation, which facilitates detached observation and paying attention to the present moment with openness, curiosity, and acceptance, has recently been studied as a smoking cessation intervention.

Aims: This review synthesizes randomized controlled trials (RCTs) of mindfulness meditation (MM) interventions for smoking cessation.

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources.

Acupuncture for Major Depressive Disorder: A Systematic Review.

Major depressive disorder (MDD) is a prevalent condition associated with significant burden in terms of reduced quality of life, lower productivity, increased prevalence of other conditions and increased health care costs. We conducted a systematic review and qualitative summary of randomized controlled trials (RCTs) that assessed the effectiveness and safety of acupuncture for the treatment of MDD. We searched the databases PubMed, CINAHL, PsycINFO, Web of Science, Embase, CDSR, CENTRAL, clinicaltrials.

Association Between the Opening of Retail Clinics and Low-Acuity Emergency Department Visits.

Study Objective: We assess whether the opening of retail clinics near emergency departments (ED) is associated with decreased ED utilization for low-acuity conditions.

Methods: We used data from the Healthcare Cost and Utilization Project State Emergency Department Databases for 2,053 EDs in 23 states from 2007 to 2012. We used Poisson regression models to examine the association between retail clinic penetration and the rate of ED visits for 11 low-acuity conditions.

Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty.

Background: Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital's control, may not accurately reflect a hospital's performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA.

Acupuncture for substance use disorders: A systematic review and meta-analysis.

Background: This systematic review aims to estimate the effects of acupuncture for adults with substance use disorders (SUDs).

Methods: We searched 7 electronic databases and bibliographies of previous studies to identify eligible randomized trials. Two independent reviewers screened citations, extracted data, and assessed risks of bias.

An Examination of Hospital Nurse Staffing and Patient Experience with Care: Differences between Cross-Sectional and Longitudinal Estimates.

Objective: To study the association between hospital nurse staffing and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

Data Sources: State hospital financial and utilization reports, Healthcare Cost and Utilization Project State Inpatient Databases, HCAHPS survey, and American Hospital Association Annual Survey of Hospitals.

Study Design: Retrospective study using cross-sectional and longitudinal models to estimate the effect of nurse staffing levels and skill mix on seven HCAHPS measures.

Cost of Transformation among Primary Care Practices Participating in a Medical Home Pilot.

Background: Medical home initiatives encourage primary care practices to invest in new structural capabilities such as patient registries and information technology, but little is known about the costs of these investments.

Objectives: To estimate costs of transformation incurred by primary care practices participating in a medical home pilot.

Design: We interviewed practice leaders in order to identify changes practices had undertaken due to medical home transformation.

Patient Use of Cost and Quality Data When Choosing a Joint Replacement Provider in the Context of Reference Pricing.

Health plans are encouraging consumerism among joint replacement patients by reporting information on hospital costs and quality. Little is known about how the proliferation of such initiatives impacts patients' selection of a surgeon and hospital. We performed a qualitative analysis of semistructured interviews with 13 patients who recently received a hip or knee replacement surgery.

Categories of Practice Transformation in a Statewide Medical Home Pilot and their Association with Medical Home Recognition.

Background: Healthcare purchasers have created financial incentives for primary care practices to achieve medical home recognition. Little is known about how changes in practice structure vary across practices or relate to medical home recognition.

Objective: We aimed to characterize patterns of structural change among primary care practices participating in a statewide medical home pilot.