Health Care Reform and Primary Care — The Growing Importance of the Community Health Center

Adashi, Eli Y.; Geiger, Hartmut; Fine, Michael

doi:10.1056/nejmp1003729

Cited by 194 publications

(144 citation statements)

References 3 publications

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“…The expansion of the centers has the potential to reduce low-acuity emergency department visits, given the centers' explicit mission to manage the care of people with acute medical problems. 29 Enhanced rates of reimbursement-another feature of the Affordable Care Act-may also spur some practitioners to expand access and may attract more medical students to primary care. But the pipeline will take years, if not decades, to catch up.…”

Section: -21mentioning

confidence: 99%

Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office

et al. 2010

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Historically, general practitioners provided first-contact care in the United States. Today, however, only 42 percent of the 354 million annual visits for acute care-treatment for newly arising health problems -are made to patients' personal physicians. The rest are made to emergency departments (28 percent), specialists (20 percent), or outpatient departments (7 percent). Although fewer than 5 percent of doctors are emergency physicians, they handle a quarter of all acute care encounters and more than half of such visits by the uninsured. Health reform provisions in the Patient Protection and Affordable Care Act that advance patient-centered medical homes and accountable care organizations are intended to improve access to acute care. The challenge for reform will be to succeed in the current, complex acute care landscape.

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Section: -21mentioning

confidence: 99%

Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office

et al. 2010

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“…In addition, expanding the role and scope of practice (SOP) of NPs in the delivery of primary care (e.g., independent practice and prescription authority) has had a significant impact on access to primary care and improved management of chronic diseases among vulnerable populations, including Medicaid enrollees (Adashi, Geiger, & Fine, 2010;Landon et al, 2007). Supporting an expanded SOP for NPs is an extensive body of evidence that has consistently demonstrated comparable performance between NPs and PCPs on clinical outcomes, including reduction of symptoms, improvement in health and functional status, and mortality (Naylor & Kurtzman, 2010;Paradise, Dark, & Bitler, 2011).…”

Section: Introductionmentioning

confidence: 99%

Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

et al. 2016

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a b s t r a c tBackground: One proposed strategy to expand primary care capacity is to use nurse practitioners (NPs) more effectively in health care delivery. However, the ability of NPs to provide care to the fullest extent of their education is moderated by state scope-of-practice (SOP) regulations. Purpose: The purpose of this study was to examine the impact of state SOP regulations on the following three key issues: (a) NP workforce, (b) access to care and health care utilization, and (c) health care costs. Methods: Systematic review. Results/Discussion: States granting NPs greater SOP authority tend to exhibit an increase in the number and growth of NPs, greater care provision by NPs, and expanded health care utilization, especially among rural and vulnerable populations. Our review indicates that expanded NP practice regulation can impact health care delivery by increasing the number of NPs in combination with easing restrictions on their SOP. Conclusions: Findings show promise that removing restrictions on NP SOP regulations could be a viable and effective strategy to increase primary care capacity.

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“…As stated in Section 330 of the Public Health Service Act, CHCs must focus on the community health needs of local populations (National Association of Community Health Centers, 2011). With their host communities involved in their governance, CHCs were to be "of the people, by the people, for the people" (Adashi et al, 2010).…”

Section: Discussionmentioning

confidence: 99%