Call to action: APRNs in US nursing homes to improve care and reduce costs

被引:25
作者
Rantz, Marilyn J. [1 ]
Birtley, Nancy M. [1 ]
Flesner, Marcia [1 ]
Crecelius, Charles [1 ]
Murray, Cathy [1 ]
机构
[1] Univ Missouri, Sinclair Sch Nursing, Columbia, MO USA
关键词
Missouri Quality Initiative; Medicare; Nurse practitioners; Long-term care facilities; AVOIDABLE HOSPITALIZATIONS; QUALITY IMPROVEMENT; HEALTH OUTCOMES; PRACTITIONERS; NURSES; TRIAL;
D O I
10.1016/j.outlook.2017.08.011
中图分类号
R47 [护理学];
学科分类号
1011 ;
摘要
Background: Centers for Medicare and Medicaid Innovation Center sponsored the initiative to reduce avoidable hospitalizations among nursing facility residents. Purpose: Missouri Quality Initiative (MOQI) designed inter-professional model in nursing homes with advanced practice registered nurses (APRNs). Method: MOQI APRN model was implemented for 4 years in 16 nursing homes in a metro area of the Midwest. Hospitalizations were reduced (40% all-cause, 58% potentially avoidable), emergency room visits (54% all-cause, 65% potentially avoidable), Medicare expenditures for hospitalizations (34% all-cause, 45% potentially avoidable), and Medicare expenditures for emergency room visits (50% all-cause, 60% potentially avoidable) for long-stay nursing home residents. Discussion: Success of the MOQI model reinforces decades of research demonstrating that care provided by APRNs is cost-effective, safe, and associated with positive health outcomes and patient satisfaction. Conclusion: Nursing homes can implement and benefit by hiring APRNs. However, changes in the Code of Federal Regulation (CFR 483.40) are necessary to improve patient access to care and encourage hiring APRNs in US nursing homes.
引用
收藏
页码:689 / 696
页数:8
相关论文
共 40 条
[1]  
Aigner Mary J, 2004, J Am Med Dir Assoc, V5, P16, DOI 10.1016/S1525-8610(04)70039-0
[2]   Preparing Nursing Homes for the Future of Health Information Exchange [J].
Alexander, G. L. ;
Rantz, M. ;
Galambos, C. ;
Vogelsmeier, A. ;
Flesner, M. ;
Popejoy, L. ;
Mueller, J. ;
Shumate, S. ;
Elvin, M. .
APPLIED CLINICAL INFORMATICS, 2015, 6 (02) :248-266
[3]  
Baker A. S., 2010, A WEBNAR SERIES
[4]  
Burl J B, 1994, HMO Pract, V8, P157
[5]   Geriatric nurse practitioners in long-term care: Demonstration of effectiveness in managed care [J].
Burl, JB ;
Bonner, A ;
Rao, M ;
Khan, AM .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1998, 46 (04) :506-510
[6]   Analysis of Advance Directive Documentation to Support Palliative Care Activities in Nursing Homes [J].
Galambos, Colleen ;
Starr, Julie ;
Rantz, Marilyn J. ;
Petroski, Gregory F. .
HEALTH & SOCIAL WORK, 2016, 41 (04) :228-234
[7]   Using FOCUS PDSA to Improve Antipsychotic Medication Management [J].
Hampton, J. Keith ;
Reiter, Teri ;
Hogarth, Joan ;
Doerr, Jan ;
Bohack, Karen ;
Popejoy, Lori .
JOURNAL OF NURSING CARE QUALITY, 2014, 29 (04) :295-302
[8]   Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors [J].
Horrocks, S ;
Anderson, E ;
Salisbury, C .
BRITISH MEDICAL JOURNAL, 2002, 324 (7341) :819-823
[9]  
Indeed, 2017, NURSE PRACTITIONER S
[10]   Initiative To Reduce Avoidable Hospitalizations Among Nursing Facility Residents Shows Promising Results [J].
Ingber, Melvin J. ;
Feng, Zhanlian ;
Khatutsky, Galina ;
Wang, Joyce M. ;
Bercaw, Lawren E. ;
Zheng, Nan Tracy ;
Vadnais, Alison ;
Coomer, Nicole M. ;
Segelman, Micah .
HEALTH AFFAIRS, 2017, 36 (03) :441-450