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A model of care redesign within rheumatology: A mixed methods approach integrating nurse practitioners and physician assistants.

J Am Assoc Nurse Pract

January 2025

Division of Cardiology, Department of Medicine, Duke Health Integrated Practice, Duke University Health System, Durham, North Carolina.

Background: Increasing patient demand and clinician burnout in rheumatology practices have highlighted the need for more efficient models of care (MOC). Interprofessional collaboration is essential for improving patient outcomes and clinician satisfaction.

Local Problem: Our current MOC lacks standardization and formal integration of Nurse Practitioners (NPs) and Physician Assistants (PAs), resulting in reduced clinician satisfaction and limited patient access.

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Background: The implementation of large language models (LLMs), such as BART (Bidirectional and Auto-Regressive Transformers) and GPT-4, has revolutionized the extraction of insights from unstructured text. These advancements have expanded into health care, allowing analysis of social media for public health insights. However, the detection of drug discontinuation events (DDEs) remains underexplored.

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Importance: Rising prescription medication costs under Medicaid have led to increased procedural prescription denials by health plans. The effect of unresolved denials on chronic condition exacerbation and subsequent acute care utilization remains unclear.

Objective: To examine whether procedural prescription denials are associated with increased net spending through downstream acute care utilization among Medicaid patients not obtaining prescribed medication following a denial.

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This meta-review provides the first meta-analytic evidence from published meta-analyses examining the effectiveness of acute exercise interventions on cognitive function. A multilevel meta-analysis with a random-effects model and tests of moderators were performed in R. Thirty systematic reviews with meta-analyses (383 unique studies with 18,347 participants) were identified.

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