Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease.

Publisher: Springer Country of Publication: United States NLM ID: 8605834 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1497 (Electronic) Linking ISSN: 08848734 NLM ISO Abbreviation: J Gen Intern Med Subsets: MEDLINE

Publication: Secaucus, NJ : Springer
Original Publication: [Philadelphia, PA] : Hanley & Belfus, [c1986-

Ethnicity* ; Coronary Disease*/therapy; Humans ; Aged ; United States/epidemiology ; Cross-Sectional Studies ; Medicare ; Minority Groups ; Hospitalization ; Healthcare Disparities

Background: Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients.
Objective: To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease.
Design: In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018-2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease.
Participants: A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included.
Main Measures: All-cause and ambulatory care sensitive condition hospitalizations in 2018.
Key Results: There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88-0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20-1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92-0.99) for all beneficiaries.
Conclusions: Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations.
(© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics-2021 Update: a Report from the American Heart Association. Circulation. 2021;143(8):e254-e743. https://doi.org/10.1161/CIR.0000000000000950. (PMID: 10.1161/CIR.000000000000095033501848)
Centers for Disease Control and Prevention. Coronary heart disease, myocardial infarction, and stroke — a public health issue. https://www.cdc.gov/aging/publications/coronary-heart-disease-brief.html . Accessed October 10, 2022.
Feinstein M, Ning H, Kang J, Bertoni A, Carnethon M, Lloyd-Jones DM. Racial Differences in Risks for First Cardiovascular Events and Non-cardiovascular Death: the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis. Circulation. 2012;126(1):50-59. https://doi.org/10.1161/CIRCULATIONAHA.111.057232. (PMID: 10.1161/CIRCULATIONAHA.111.057232226933513437934)
Churchwell K, Elkind MS, Benjamin RM, et al. Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: a Presidential Advisory from the American Heart Association. Circulation. 2020;142(24):e454-e468. https://doi.org/10.1161/CIR.0000000000000936. (PMID: 10.1161/CIR.000000000000093633170755)
Havranek EP, Mujahid MS, Barr DA, et al. Social Determinants of Risk and Outcomes for Cardiovascular Disease: a Scientific Statement from the American Heart Association. Circulation. 2015;132(9):873-98. https://doi.org/10.1161/CIR.0000000000000228. (PMID: 10.1161/CIR.000000000000022826240271)
Chen Y, Freedman ND, Albert PS, et al. Association of Cardiovascular Disease with Premature Mortality in the United States. JAMA Cardiol. 2019;4(12):1230-1238. https://doi.org/10.1001/jamacardio.2019.3891. (PMID: 10.1001/jamacardio.2019.3891316178636802055)
Landon BE, Onnela JP, Meneades L, O’Malley AJ, Keating NL. Assessment of Racial Disparities in Primary Care Physician Specialty Referrals. JAMA Netw Open. 2021;4(1):e2029238. https://doi.org/10.1001/jamanetworkopen.2020.29238. (PMID: 10.1001/jamanetworkopen.2020.29238334923737835717)
Shahu A, Okunrintemi V, Tibuakuu M, et al. Income Disparity and Utilization of Cardiovascular Preventive Care Services Among U.S. Adults. Am J Prev Cardiol. 2021;8:100286. https://doi.org/10.1016/j.ajpc.2021.100286. (PMID: 10.1016/j.ajpc.2021.10028634816144)
Castellanos LR, Viramontes O, Bains NK, Zepeda IA. Disparities in Cardiac Rehabilitation Among Individuals from Racial and Ethnic Groups and Rural Communities—a Systematic Review. J Racial Ethn Health Disparities. 2019;6(1):1-11. https://doi.org/10.1007/s40615-018-0478-x. (PMID: 10.1007/s40615-018-0478-x29536369)
Dorsch MP, Lester CA, Ding Y, Joseph M, Brook RD. Effects of Race on Statin Prescribing for Primary Prevention with High Atherosclerotic Cardiovascular Disease Risk in a Large Healthcare System. J Am Heart Assoc. 2019;8(22):e014709. https://doi.org/10.1161/JAHA.119.014709. (PMID: 10.1161/JAHA.119.014709317079436915275)
FitzGerald C, Hurst S. Implicit Bias in Healthcare Professionals: a Systematic Review. BMC Med Ethics. 2017;18(1):19. https://doi.org/10.1186/s12910-017-0179-8. (PMID: 10.1186/s12910-017-0179-8282495965333436)
Banerjee S, Aaysha Cader F, Gulati M, Capers Q. Racism and Cardiology: a Global Call to Action. CJC Open. 2021;3(12 Suppl):S165-s173. https://doi.org/10.1016/j.cjco.2021.09.014. (PMID: 10.1016/j.cjco.2021.09.014349934458712707)
Javed Z, Haisum Maqsood M, Yahya T, et al. Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease. Circ Cardiovasc Qual Outcomes. 2022;15(1):e007917. https://doi.org/10.1161/CIRCOUTCOMES.121.007917. (PMID: 10.1161/CIRCOUTCOMES.121.00791735041484)
Dong L, Fakeye OA, Graham G, Gaskin DJ. Racial/Ethnic Disparities in Quality of Care for Cardiovascular Disease in Ambulatory Settings: a Review. Med Care Res Rev. 2018;75(3):263-291. https://doi.org/10.1177/1077558717725884. (PMID: 10.1177/107755871772588428882087)
Becker DM, Raqueño JV, Yook RM, et al. Nurse-Mediated Cholesterol Management Compared with Enhanced Primary Care in Siblings of Individuals with Premature Coronary Disease. Arch Intern Med. 1998;158(14):1533-9. https://doi.org/10.1001/archinte.158.14.1533. (PMID: 10.1001/archinte.158.14.15339679794)
DeBusk RF, Miller NH, Superko HR, et al. A Case-Management System for Coronary Risk Factor Modification After Acute Myocardial Infarction. Arch Intern Med. 1994/05/01 1994;120(9):721-729. https://doi.org/10.7326/0003-4819-120-9-199405010-00001.
West JA, Miller NH, Parker KM, et al. A Comprehensive Management System for Heart Failure Improves Clinical Outcomes and Reduces Medical Resource Utilization. The American Journal of Cardiology. 1997/01/01/ 1997;79(1):58-63. https://doi.org/10.1016/S0002-9149(96)00676-5.
Smith CE, Piamjariyakul U, Dalton KM, Russell C, Wick J, Ellerbeck EF. Nurse-Led Multidisciplinary Heart Failure Group Clinic Appointments: Methods, Materials, and Outcomes Used in the Clinical Trial. J Cardiovasc Nurs. Jul-Aug 2015;30(4 Suppl 1): S25-34. https://doi.org/10.1097/jcn.0000000000000255. (PMID: 10.1097/jcn.0000000000000255)
Paul S. Impact of a nurse-managed heart failure clinic: a pilot study. Am J Crit Care. 2000;9(2):140-6. (PMID: 10.4037/ajcc2000.9.2.14010705427)
Lowery J, Hopp F, Subramanian U, et al. Evaluation of a Nurse Practitioner Disease Management Model for Chronic Heart Failure: a Multi-site Implementation Study. Congest Heart Fail. 2012;18(1):64-71. https://doi.org/10.1111/j.1751-7133.2011.00228.x. (PMID: 10.1111/j.1751-7133.2011.00228.x22277180)
Bryant R, Himawan L. Heart Failure Self-care Program Effect on Outcomes. J Nurse Pract. 2019/05/01/ 2019;15(5):379-381. https://doi.org/10.1016/j.nurpra.2018.08.035.
Blum K, Gottlieb SS. The Effect of a Randomized Trial of Home Telemonitoring on Medical Costs, 30-Day Readmissions, Mortality, and Health-Related Quality of Life in a Cohort of Community-Dwelling Heart Failure Patients. J Card Fail. 2014/07/01/ 2014;20(7):513-521. https://doi.org/10.1016/j.cardfail.2014.04.016.
Benatar D, Bondmass M, Ghitelman J, Avitall B. Outcomes of Chronic Heart Failure. Arch Intern Med. 2003;163(3):347-352. https://doi.org/10.1001/archinte.163.3.347. (PMID: 10.1001/archinte.163.3.34712578516)
Martsolf GR, Barnes H, Richards MR, Ray KN, Brom HM, McHugh MD. Employment of Advanced Practice Clinicians in Physician Practices. JAMA Intern Med. 2018;178(7):988-990. https://doi.org/10.1001/jamainternmed.2018.1515. (PMID: 10.1001/jamainternmed.2018.1515)
Allen JK, Blumenthal RS, Margolis S, Young DR, Miller ER, 3rd, Kelly K. Nurse Case Management of Hypercholesterolemia in Patients with Coronary Heart Disease: Results of a Randomized Clinical Trial. Am Heart J. 2002;144(4):678-86. https://doi.org/10.1067/mhj.2002.124837. (PMID: 10.1067/mhj.2002.12483712360165)
Paez KA, Allen JK. Cost-effectiveness of Nurse Practitioner Management of Hypercholesterolemia Following Coronary Revascularization. J Am Acad Nurse Pract. 2006;18(9):436-44. https://doi.org/10.1111/j.1745-7599.2006.00159.x. (PMID: 10.1111/j.1745-7599.2006.00159.x16958775)
Hall MH, Esposito RA, Pekmezaris R, et al. Cardiac Surgery Nurse Practitioner Home Visits Prevent Coronary Artery Bypass Graft Readmissions. Ann Thorac Surg. 2014;97(5):1488-93; discussion 1493-5. https://doi.org/10.1016/j.athoracsur.2013.12.049. (PMID: 10.1016/j.athoracsur.2013.12.04924612701)
Goldie CL, Prodan-Bhalla N, Mackay M. Nurse practitioners in postoperative cardiac surgery: are they effective? Can J Cardiovasc Nurs. Fall 2012;22(4):8-15.
Sawatzky JA, Christie S, Singal RK. Exploring Outcomes of a Nurse Practitioner-Managed Cardiac Surgery Follow-up Intervention: a Randomized Trial. J Adv Nurs. 2013;69(9):2076-87. https://doi.org/10.1111/jan.12075. (PMID: 10.1111/jan.1207523317314)
Harbman P. The Development and Testing of a Nurse Practitioner Secondary Prevention Intervention for Patients After Acute Myocardial Infarction: a Prospective Cohort Study. Int J Nurs Stud. 2014/12/01/ 2014;51(12):1542-1556. https://doi.org/10.1016/j.ijnurstu.2014.04.004.
Kerr L, Kalowes P, Dyo M. Nurse Practitioner–Led Project to Achieve Euglycemia in Cardiac Surgery Patients. J Nurse Pract. 2017/03/01/ 2017;13(3):e137-e141. https://doi.org/10.1016/j.nurpra.2016.10.016.
Xue Y, Goodwin JS, Adhikari D, Raji MA, Kuo YF. Trends in Primary Care Provision to Medicare Beneficiaries by Physicians, Nurse Practitioners, or Physician Assistants: 2008-2014. J Prim Care Community Health. 2017;8(4):256-263. https://doi.org/10.1177/2150131917736634. (PMID: 10.1177/2150131917736634290473225932742)
Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of Primary Care Physician Supply with Population Mortality in the United States, 2005-2015. JAMA Intern Med. 2019;179(4):506-514. https://doi.org/10.1001/jamainternmed.2018.7624. (PMID: 10.1001/jamainternmed.2018.7624307760566450307)
Health Resources & Services Administration. Primary care workforce projections. https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand/primary-health . Accessed September 20, 2022.
Swan M, Ferguson S, Chang A, Larson E, Smaldone A. Quality of Primary Care by Advanced Practice Nurses: a Systematic Review. Intl J Qual Health Care. 2015;27(5):396-404. https://doi.org/10.1093/intqhc/mzv054. (PMID: 10.1093/intqhc/mzv054)
Kurtzman ET, Barnow BS. A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians’ Patterns of Practice and Quality of Care in Health Centers. Med Care. 2017;55(6):615-622. https://doi.org/10.1097/MLR.0000000000000689. (PMID: 10.1097/MLR.000000000000068928234756)
Yang BK, Johantgen ME, Trinkoff AM, Idzik SR, Wince J, Tomlinson C. State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: a Systematic Review. Med Care Res Rev. 2021;78(3):183-196. https://doi.org/10.1177/1077558719901216. (PMID: 10.1177/107755871990121631997710)
Poghosyan L, Nannini A, Clarke S. Organizational Climate in Primary Care Settings: Implications for Nurse Practitioner Practice. J Am Assoc Nurse Pract. 2013;25(3):134-40. https://doi.org/10.1111/j.1745-7599.2012.00765.x. (PMID: 10.1111/j.1745-7599.2012.00765.x24218200)
Poghosyan L, Norful AA, Martsolf GR. Primary Care Nurse Practitioner Practice Characteristics: Barriers and Opportunities for Interprofessional Teamwork. J Ambul Care Manage. 2017;40(1):77-86. https://doi.org/10.1097/JAC.0000000000000156. (PMID: 10.1097/JAC.0000000000000156279025555484049)
Poghosyan L, Ghaffari A, Liu J, McHugh MD. Organizational Support for Nurse Practitioners in Primary Care and Workforce Outcomes. Nurs Res. 2020;69(4):280-288. https://doi.org/10.1097/NNR.0000000000000425. (PMID: 10.1097/NNR.0000000000000425320584579869754)
Carthon JMB, Brom H, Poghosyan L, Daus M, Todd B, Aiken L. Supportive Clinical Practice Environments Associated with Patient-Centered Care. J Nurse Pract. 2020;16(4):294-298. https://doi.org/10.1016/j.nurpra.2020.01.019. (PMID: 10.1016/j.nurpra.2020.01.019328637987454202)
Carthon MB, Brom H, Nikpour J, Todd B, Aiken L, Poghosyan L. Supportive Practice Environments Are Associated with Higher Quality Ratings Among Nurse Practitioners Working in Underserved Areas. J Nurs Regul. 2022;13(1):5-12. https://doi.org/10.1016/s2155-8256(22)00028-x. (PMID: 10.1016/s2155-8256(22)00028-x362491629555817)
Poghosyan L, Norful AA, Liu J, Friedberg MW. Nurse Practitioner Practice Environments in Primary Care and Quality of Care for Chronic Diseases. Med Care. 2018;56(9):791-797. https://doi.org/10.1097/MLR.0000000000000961. (PMID: 10.1097/MLR.0000000000000961300157246202056)
Poghosyan L, Liu J, Perloff J, et al. Primary Care Nurse Practitioner Work Environments and Hospitalizations and ED Use Among Chronically Ill Medicare Beneficiaries. Med Care. 2022;60(7):496-503. https://doi.org/10.1097/MLR.0000000000001731. (PMID: 10.1097/MLR.0000000000001731356791739202077)
Harrison J, Germack H, Poghosyan L, D’Aunno T, Martsolf G. Methodology for a six-state survey of primary care nurse practitioners. Nursing Outlook. 2021;69(4):609-616. (PMID: 10.1016/j.outlook.2021.01.010335936678362822)
American Association of Nurse Practitioners. State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment . Accessed October 12, 2022.
Barnes H, Richards MR, McHugh MD, Martsolf G. Rural and Nonrural Primary Care Physician Practices Increasingly Rely on Nurse Practitioners. Health Aff (Millwood). 2018;37(6):908-914. https://doi.org/10.1377/hlthaff.2017.1158. (PMID: 10.1377/hlthaff.2017.1158298639336080248)
IQVIA Inc. OneKey reference assets. https://www.iqvia.com/locations/united-states/solutions/commercial-operations/essential-information/onekey-reference-assets . Accessed October 12, 2022.
Dillman DA, Smyth JD, Christian LM. Internet, phone, mail, and mixed-mode surveys: the tailored design method, 4th ed. Hoboken, NJ: John Wiley & Sons Inc; 2014.
Centers for Medicare & Medicaid Services. Chronic conditions. https://www2.ccwdata.org/web/guest/condition-categories-chronic . Accessed July 1, 2022.
Mehrotra A, Adams JL, Thomas JW, McGlynn EA. The Effect of Different Attribution Rules on Individual Physician Cost Profiles. Ann Intern Med. 2010;152(10):649-54. https://doi.org/10.1059/0003-4819-152-10-201005180-00005. (PMID: 10.1059/0003-4819-152-10-201005180-00005204790302990946)
Amjad H, Carmichael D, Austin AM, Chang CH, Bynum JP. Continuity of Care and Health Care Utilization in Older Adults with Dementia in Fee-for-Service Medicare. JAMA Intern Med. 2016;176(9):1371-8. https://doi.org/10.1001/jamainternmed.2016.3553. (PMID: 10.1001/jamainternmed.2016.3553274549455061498)
Eicheldinger C, Bonito A. More Accurate Racial and Ethnic Codes for Medicare Administrative Data. Health Care Financ Rev. 2008;29(3):27. (PMID: 185672414195038)
Jarrín OF, Nyandege AN, Grafova IB, Dong X. The Source Matters: Agreement and Accuracy of Race and Ethnicity Codes in Medicare Administrative and Assessment Data. 2019. https://doi.org/10.31219/osf.io/ts98h.
Filice CE, Joynt KE. Examining Race and Ethnicity Information in Medicare Administrative Data. Med Care. 2017;55(12):e170-e176. https://doi.org/10.1097/MLR.0000000000000608. (PMID: 10.1097/MLR.000000000000060829135782)
Poghosyan L, Nannini A, Finkelstein SR, Mason E, Shaffer JA. Development and Psychometric Testing of the Nurse Practitioner Primary Care Organizational Climate Questionnaire. Nurs Res. 2013;62(5):325-34. https://doi.org/10.1097/NNR.0b013e3182a131d2. (PMID: 10.1097/NNR.0b013e3182a131d223995466)
Poghosyan L, Liu J, Shang J, D’Aunno T. Practice Environments and Job Satisfaction and Turnover Intentions of Nurse Practitioners: Implications for Primary Care Workforce Capacity. Health Care Manage Rev. 2017;42(2):162–171. https://doi.org/10.1097/HMR.0000000000000094. (PMID: 10.1097/HMR.000000000000009426587998)
Ho LH, Chang SC, Kau K, et al. The Impact of Organizational Support on Practice Outcomes in Nurse Practitioners in Taiwan. J Nurs Res. 2021;29(3):e148. https://doi.org/10.1097/jnr.0000000000000425. (PMID: 10.1097/jnr.0000000000000425337565198126501)
Alexander GL, Kueakomoldej S, Congdon C, Poghosyan L. A Qualitative Study Exploring Nursing Home Care Environments where Nurse Practitioners Work. Geriatr Nurs. 2023;50:44-51. https://doi.org/10.1016/j.gerinurse.2022.12.020. (PMID: 10.1016/j.gerinurse.2022.12.02036641855)
Schlak AE, Poghosyan L, Liu J, et al. The Association Between Health Professional Shortage Area (HPSA) Status, Work Environment, and Nurse Practitioner Burnout and Job Dissatisfaction. J Health Care Poor Underserved. 2022;33(2):998-1016. https://doi.org/10.1353/hpu.2022.0077. (PMID: 10.1353/hpu.2022.0077355748909306412)
Poghosyan L, Liu J, Perloff J, et al. Primary Care Nurse Practitioner Work Environments and Hospitalizations and ED Use Among Chronically Ill Medicare Beneficiaries. Medical Care. 2022;60(7):496-503. https://doi.org/10.1097/mlr.0000000000001731. (PMID: 10.1097/mlr.0000000000001731356791739202077)
James LR, Jones AP. Organizational Climate: a Review of Theory and Research. Psychol Bull. 1974;81(12):1096-1112. https://doi.org/10.1037/h0037511. (PMID: 10.1037/h0037511)
Bono C, Ried LD, Kimberlin C, Vogel B. Missing Data on the Center for Epidemiologic Studies Depression Scale: a Comparison of 4 Imputation Techniques. Res Social Adm Pharm. 2007;3(1):1-27. https://doi.org/10.1016/j.sapharm.2006.04.001. (PMID: 10.1016/j.sapharm.2006.04.00117350555)
Rosano A, Loha CA, Falvo R, et al. The Relationship Between Avoidable Hospitalization and Accessibility to Primary Care: a Systematic Review. Eur J Public Health. 2013;23(3):356-60. https://doi.org/10.1093/eurpub/cks053. (PMID: 10.1093/eurpub/cks05322645236)
Billings J, Zeitel L, Lukomnik J, Carey TS, Blank AE, Newman L. Impact of Socioeconomic Status on Hospital Use in New York City. Health affairs (Project Hope). Spring 1993;12(1):162-73. https://doi.org/10.1377/hlthaff.12.1.162.
Agency for Healthcare Research and Quality. Prevention quality indicators technical specifications. Version 2020. https://qualityindicators.ahrq.gov/archive/psi_techspec/icd10_v2020 . Accessed June 14, 2023.
Maciejewski ML, Hammill BG. Measuring the Burden of Multimorbidity Among Medicare Beneficiaries via Condition Counts and Cumulative Duration. Health Serv Res. 2019;54(2):484-491. https://doi.org/10.1111/1475-6773.13124. (PMID: 10.1111/1475-6773.13124307902816407342)
Martsolf GR, Ashwood S, Friedberg MW, Rodriguez HP. Linking Structural Capabilities and Workplace Climate in Community Health Centers. Inquiry. 2018;55:46958018794542. https://doi.org/10.1177/0046958018794542. (PMID: 10.1177/004695801879454230168364)
Maas CJM. Sufficient Sample Sizes for Multilevel Modeling. Methodology. 2005;1(3):85-91. https://doi.org/10.1027/1614-2241.1.3.85. (PMID: 10.1027/1614-2241.1.3.85)
SAS. Version 9.4. SAS Institute Inc; 2013.
Hasnain-Wynia R, Baker DW, Nerenz D, et al. Disparities in Health Care Are Driven by Where Minority Patients Seek Care: Examination of the Hospital Quality Alliance Measures. Arch Intern Med. 2007;167(12):1233-1239. https://doi.org/10.1001/archinte.167.12.1233. (PMID: 10.1001/archinte.167.12.123317592095)
López L, Jha AK. Outcomes for Whites and Blacks at Hospitals that Disproportionately Care for Black Medicare Beneficiaries. Health Serv Res. 2013;48(1):114-128. https://doi.org/10.1111/j.1475-6773.2012.01445.x. (PMID: 10.1111/j.1475-6773.2012.01445.x22816447)
Germack HD, Harrison J, Poghosyan L, Martsolf GR. Practice Patterns, Work Environments, and Job Outcomes of Rural and Urban Primary Care Nurse Practitioners. Med Care Res Rev. 2022;79(1):161-170. https://doi.org/10.1177/1077558720974537. (PMID: 10.1177/107755872097453733213271)
KFF. Distribution of Medicare beneficiaries by race/ethnicity. Accessed July 5, 2023. https://www.kff.org/medicare/state-indicator/medicare-beneficiaries-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics—2019 Update: a Report from the American Heart Association. Circulation. 2019;139(10):e56-e528. https://doi.org/10.1161/CIR.0000000000000659. (PMID: 10.1161/CIR.000000000000065930700139)
American Association of Nurse Practitioners. Nurse practitioners in primary care. https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioners-in-primary-care . Accessed October 8, 2022.
Centers for Medicare & Medicaid Services. 42 § 410.26 Services and supplies incident to a physician’s professional services: conditions.
Schram AP. Medical Home and the Nurse Practitioner: a Policy Analysis. J Nurse Pract. 2010;6(2):132-139. https://doi.org/10.1016/j.nurpra.2009.04.014. (PMID: 10.1016/j.nurpra.2009.04.014)
Lasater KB, Jarrín OF, Aiken LH, McHugh MD, Sloane DM, Smith HL. A Methodology for Studying Organizational Performance: a Multistate Survey of Front-Line Providers. Med Care. 2019;57(9):742. https://doi.org/10.1097/MLR.0000000000001167. (PMID: 10.1097/MLR.0000000000001167312747826690788)
Cho YI, Johnson TP, VanGeest JB. Enhancing Surveys of Health Care Professionals: a Meta-analysis of Techniques to Improve Response. Eval Health Prof. 2013;36(3):382-407. https://doi.org/10.1177/0163278713496425. (PMID: 10.1177/016327871349642523975761)

R01 MD011514 United States MD NIMHD NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS

Keywords: coronary heart disease; nurse practitioner

Date Created: 20230824 Date Completed: 20240129 Latest Revision: 20240312

20240312

PMC10817858

10.1007/s11606-023-08367-1

37620724