Project

Aging Patients and Health Professionals: New Roles in a Changing Health System

Goal: Specific Aims
1. Trace the historical and present roles of, and relationships among, patients/caregivers, social workers, nurses and physicians in the US health care system from 1965 (the advent of Medicare) to the present day to map key domains of individual competencies, roles and collective responsibilities and create an analytic framework for future study of health care teams.
2. Apply the framework to Investigate and explore in qualitative (focus groups, site visits) and quantitative data (nationally representative surveys) the extant roles and preferences of frail elderly patients/caregivers, social workers, nurses and physicians in multiple working models of autonomous and collaborative practice to map present practice reality to the theoretical, historical framework.
3. Gather empirical data to inform analyses of the cost and quality of care models for frail elders living in community from the perspective of patients/family and payers.

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Project log

Karen Donelan
added a research item
The U.S. health care system is at a critical juncture in health care workforce planning. The nation has a shortage of primary care physicians. Policy analysts have proposed expanding the supply and scope of practice of nurse practitioners to address increased demand for primary care providers. These proposals are controversial. From November 23, 2011, to April 9, 2012, we conducted a national postal-mail survey of 972 clinicians (505 physicians and 467 nurse practitioners) in primary care practice. Questionnaire domains included scope of work, practice characteristics, and attitudes about the effect of expanding the role of nurse practitioners in primary care. The response rate was 61.2%. Physicians reported working longer hours, seeing more patients, and earning higher incomes than did nurse practitioners. A total of 80.9% of nurse practitioners reported working in a practice with a physician, as compared with 41.4% of physicians who reported working with a nurse practitioner. Nurse practitioners were more likely than physicians to believe that they should lead medical homes, be allowed hospital admitting privileges, and be paid equally for the same clinical services. When asked whether they agreed with the statement that physicians provide a higher-quality examination and consultation than do nurse practitioners during the same type of primary care visit, 66.1% of physicians agreed and 75.3% of nurse practitioners disagreed. Current policy recommendations that are aimed at expanding the supply and scope of practice of primary care nurse practitioners are controversial. Physicians and nurse practitioners do not agree about their respective roles in the delivery of primary care. (Funded by the Gordon and Betty Moore Foundation and others.).
Karen Donelan
added a project goal
Specific Aims
1. Trace the historical and present roles of, and relationships among, patients/caregivers, social workers, nurses and physicians in the US health care system from 1965 (the advent of Medicare) to the present day to map key domains of individual competencies, roles and collective responsibilities and create an analytic framework for future study of health care teams.
2. Apply the framework to Investigate and explore in qualitative (focus groups, site visits) and quantitative data (nationally representative surveys) the extant roles and preferences of frail elderly patients/caregivers, social workers, nurses and physicians in multiple working models of autonomous and collaborative practice to map present practice reality to the theoretical, historical framework.
3. Gather empirical data to inform analyses of the cost and quality of care models for frail elders living in community from the perspective of patients/family and payers.