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Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014
JAMA Internal Medicine ( IF 22.5 ) Pub Date : 2017-09-01 , DOI: 10.1001/jamainternmed.2017.2136
Joan M. Teno 1 , Pedro L. Gozalo 2 , Amal N. Trivedi 2 , Susan L. Mitchell 3 , Jennifer N. Bunker 1 , Vincent Mor 2
Affiliation  

Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014 Residents of nursing homes (NHs) comprise a medically complex and vulnerable population with many persons experiencing multiple comorbid conditions, frailty, and advanced dementia. Health care professionals such as physicians, nurse practitioners (NPs), and physician assistants (PAs) play an important role in managing their care. An Office of Inspector General Report1 noted that specialization of health care professionals in NH care could potentially improve care through increased presence of health care professionals in NHs, enhanced knowledge in the care of patients with medically complex conditions, and better understanding of the regulatory environment. On the contrary, specialization in 1 setting of care could result in increased fragmentation of care, giving rise to concerns about medical errors and lack of care coordination. Little empirical research is available about the number of clinicians who primarily practice in NHs or the proportion of NH care delivered by these clinicians.2 Using national Medicare Part B claims from 2007, 2010, and 2014, we characterized temporal trends in the number of physicians, NPs, and PAs concentrating their practice in the NH or skilled nursing facility (SNF) setting (ie, SNFists), the fraction of all NH and SNF claims generated by SNFists, and state variation in this phenomenon in 2014.

中文翻译:

2007 年至 2014 年熟练护理设施专家人数的时间趋势

2007 年至 2014 年熟练护理设施专家人数的时间趋势 疗养院 (NH) 的居民是一个医学复杂且脆弱的人群,其中许多人患有多种合并症、虚弱和晚期痴呆症。医生、执业护士 (NP) 和医生助理 (PA) 等医疗保健专业人员在管理他们的护理方面发挥着重要作用。监察长办公室的一份报告 1 指出,NH 护理中的医疗保健专业人员的专业化可能会通过增加 NH 中医疗保健专业人员的存在、增强对患有复杂疾病的患者的护理知识以及更好地了解监管环境来改善护理。相反,一种护理环境的专业化可能导致护理更加分散,引起对医疗错误和缺乏护理协调的担忧。关于主要在 NH 中执业的临床医生数量或这些临床医生提供的 NH 护理比例的实证研究很少。2 使用 2007、2010 和 2014 年的国家医疗保险 B 部分索赔,我们描述了医生数量的时间趋势、NP 和 PA 将他们的实践集中在 NH 或熟练护理机构 (SNF) 环境中(即 SNFists),SNFists 产生的所有 NH 和 SNF 索赔的比例,以及 2014 年这种现象的状态变化。
更新日期:2017-09-01
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