Call to action: APRNs in U.S. nursing homes to improve care and reduce costs

Rantz, Marilyn; Birtley, Nancy M.; Flesner, Marcia; Crecelius, Charles; Murray, Cathy M.

doi:10.1016/j.outlook.2017.08.011

Cited by 28 publications

(31 citation statements)

References 19 publications

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“…The positive facilitator theme presence of NPs decreasing hospitalizations was mentioned in 37 of 136 occurrences, or 27.21% [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The presence of NPs also improved health outcomes was mentioned in 27 of 136 occurrences of facilitator themes, or 19.85% [ 7 , 9 , 12 , 14 , 20 , 21 , 23 , 24 , 26 , 28 , 29 , 30 , 31 ]. Improved patient and family satisfaction were mentioned in 2 of 136 occurrences of facilitator themes, or 1.47% [ 19 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…Improved patient and family satisfaction were mentioned in 2 of 136 occurrences of facilitator themes, or 1.47% [ 19 , 32 ]. Improved quality of care was mentioned in 26 of 136 occurrences of facilitator themes, or 19.12% [ 8 , 13 , 14 , 18 , 19 , 20 , 23 , 24 , 26 , 27 , 28 , 31 , 33 ]. Improved end-of-life care was mentioned in 3 of 136 occurrences of facilitator themes, or 2.21% [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

“…Multidisciplinary approach was mentioned in 5 of 136 occurrences of facilitator themes, or 3.68% [ 21 , 25 , 29 , 32 ]. Reduced healthcare costs were mentioned in 9 of 136 occurrences of facilitator themes, or 6.62% [ 7 , 8 , 9 , 12 , 14 , 23 , 30 ]. Unrestrictive or least restrictive scope of practice for NPs was mentioned in 10 of 136 occurrences of facilitator themes, 7.35% [ 10 , 14 , 16 , 17 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

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The Impact of Nurse Practitioners on Hospitalizations and Discharges from Long-term Nursing Facilities: A Systematic Review

et al. 2020

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The objective of this study was to increase the understanding of the role a nurse practitioner (NP) has in reducing the risk of hospitalizations and improving quality outcomes among nursing facility residents. This was explored by the research team conducting a systematic literature review via Cumulative Index of Nursing and Allied Health Literature, PubMed (MEDLINE), and Academic Search Ultimate. This is of concern because of the increased rate of hospital readmissions from skilled nursing facilities. The study found that utilization of NPs as primary care providers resulted in decreased unnecessary hospitalizations, increased access to healthcare, and improved health outcomes. NPs are fundamental in building relationships with residents and families and providing them information for decision making. The utilization of NPs in a long-term care setting should be encouraged to improve access to care, decrease hospitalizations, and enhance quality of care. States with reduced or restrictive scope of practice for NPs should revisit the regulations to provide unrestricted scope of practice for NPs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Impact of Nurse Practitioners on Hospitalizations and Discharges from Long-term Nursing Facilities: A Systematic Review

et al. 2020

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“…MOQI APRNs worked with each NH to build on their strengths to manage their residents’ care and improve early illness detection and management. One major challenge of the MOQI was that APRNs could not primarily write treatment orders due to state regulatory constraints not allowing them to enter into a collaborative practice agreement and bill for services . Because of this critical constraint, ARPNs focused on building relationships with physician colleagues and changing the NH staff capacity to identify residents’ changes in health and manage illnesses.…”

Section: Resultsmentioning

confidence: 99%

Analyzing Hospital Transfers Using INTERACT Acute Care Transfer Tools: Lessons from MOQI

Popejoy

Vogelsmeier

Alexander

et al. 2019

J American Geriatrics Society

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OBJECTIVES We explored the differences in potentially avoidable/unavoidable hospital transfers in a retrospective analysis of Interventions to Reduce Acute Care Transfers (INTERACT) Acute Transfer Tools (ACTs) completed by advanced practice registered nurses (APRNs) working in the Missouri Quality Improvement (QI) Initiative (MOQI). DESIGN Cross‐sectional descriptive study of 3996 ACTs for 32.5 calendar months from 2014 to 2016. Univariate analyses examined differences between potentially avoidable vs unavoidable transfers. Multivariate logistic regression analysis of candidate factors identified those contributing to avoidable transfers. Setting Sixteen nursing homes (NHs), ranging from 120 to 321 beds, in urban, metro, and rural communities within 80 miles of a large midwestern city. PARTICIPANTS A total of 5168 residents with a median age of 82 years. MEASUREMENTS Data from 3946 MOQI‐adapted ACTs. RESULTS A total of 54% of hospital transfers were identified as avoidable. QI opportunities related to avoidable transfers were earlier detection of new signs/symptoms (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.61‐3.42; P < .001); discussions of resident/family preference (OR = 2.12; 95% CI = 1.38‐3.25; P < .001); advance directive/hospice care (OR = 2.25; 95% CI = 1.33‐3.82; P = .003); better communication about condition (OR = 4.93; 95% CI = 3.17‐7.68; P < .001); and condition could have been managed in the NH (OR = 16.63; 95% CI = 10.9‐25.37; P < .001). Three factors related to unavoidable transfers were bleeding (OR = .59; 95% CI = .46‐.77; P < .001), nausea/vomiting (OR = .7; 95% CI = .54‐.91; P = .007), and resident/family preference for hospitalization (OR = .79; 95% CI = .68‐.93; P = .003). CONCLUSION Reducing avoidable hospital transfers in NHs requires challenging assumptions about what is avoidable so QI efforts can be directed to improving NH capacity to manage ill residents. The APRNs served as the onsite coaches in the use and adoption of INTERACT. Changes in health policy would provide a revenue stream to support APRN presence in NH, a role that is critical to improving resident outcomes by increasing staff capacity to identify illness and guide system change. J Am Geriatr Soc 67:1953–1959, 2019

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“…Additional research in the United States concludes that nurse practitioners improve care and reduce costs when compared to physicians for patients covered by Medicare (Oliver, Pennington, Revelle, & Rantz, 2014;Rantz, Birtley, Flesner, Crecelius, & Murry, 2017).…”

Section: Qualit Y Of C Arementioning

confidence: 99%

A nursing solution to primary care delivery shortfall

2018

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Many countries project that they will have difficulty to meet their demand for primary care based on an inadequate supply of primary care doctors. There are many reasons for this, and they tend to vary by country. The policy options available to these countries are to increase the number of local primary care doctors, recruit doctors from other countries, ration primary care, shift more primary care to specialists, or authorize other disciplines to provide primary care. This article examines lessons learned in the United States over the past 50 years and proposes that expanding the use of nurse practitioners is the best solution when measured by feasibility, costs, ethics, and scope of the care delivered. Using nurse practitioners trained in country meets the World Health Organization global code of practice regarding the international recruitment of health personnel.

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Call to action: APRNs in U.S. nursing homes to improve care and reduce costs

Cited by 28 publications

References 19 publications

The Impact of Nurse Practitioners on Hospitalizations and Discharges from Long-term Nursing Facilities: A Systematic Review

The Impact of Nurse Practitioners on Hospitalizations and Discharges from Long-term Nursing Facilities: A Systematic Review

Analyzing Hospital Transfers Using INTERACT Acute Care Transfer Tools: Lessons from MOQI

A nursing solution to primary care delivery shortfall

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