Date Available

4-24-2018

Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Debra Hampton

Clinical Mentor

Cheryl Martin

Committee Member

Dr. Steve Hester

Committee Member

Dr. Sheila D. Melander

Abstract

Background: The Affordable Care Act, an aging population, and the increased burden of caring for the chronically ill are factors that have resulted in a significantly increased demand on primary care. This has prompted the strategy to utilize advanced practice providers (APPs) to supplement primary care physicians. Due to the inconsistency of a defined national model and measurement system, the impact of APP utilization in healthcare is not clear.

Purpose: The purpose of this project was to examine the use of APPs in primary care. The study involved a review of the current utilization of APPs, an evaluation of the impact of existing APP models, and a comparison of productivity and clinical measures between APPs and physician provider group colleagues. The outcomes of interest were ED use, readmission, productivity, pneumococcal vaccination compliance, influenza vaccination compliance and HgbA1c.

Methods: This descriptive, correlational study encompassed evaluation of the use of APP skills on select outcomes among and within the population served. The setting of this study was a primary care practice environment.

Results: Findings related to APP practice patterns, practice and individual resources and clinical outcomes did not demonstrate statistical significance. The comparison of outcomes between APPs and physician provider group demonstrated positive performance of the APP group when evaluating HgbA1c management, emergency department visits and hospital wide readmissions.

Conclusions: In order to maximize APP utilization, there is continued opportunity to allocate additional support such as social workers, pharmacists and behavioral health professionals. Continued promotion of APP utilization to top of license and associated fiscal and clinical outcomes studies will promote optimal patient outcomes.

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