Physician assistants and nurse practitioners in hospital outpatient departments, 1993-1994.

OBJECTIVE: To describe the characteristics of visits to physician assistants (PAs) and nurse practitioners (NPs) in hospital outpatient departments in the United States. METHODS: Data from the 1993 and 1994 National Hospital Ambulatory Medical Care Surveys were used to compare hospital outpatient department visits in which the patient was seen by a PA or NP, or both, with outpatient visits to all practitioners. RESULTS: An average of 64 million annual outpatient visits were made in 1993-1994, and patients were seen by PAs, NPs, or both, at 8% of these visits. PA-NP visits were more likely than total visits to occur in the Midwest, in non-urban areas, and in obstetric-gynecology clinics, and a higher proportion involved patients younger than age 25. Smaller differences were found between PA-NP visits and total outpatient visits in "reason for visit," "principal diagnosis," and "medication prescribed." CONCLUSION: Beyond the care they provide in physicians' offices and other non-hospital settings, PAs and NPs make an important contribution to ambulatory health care delivery in hospital outpatient departments.

State practice environments and the supply of physician assistants, nurse practitioners, and certified nurse-midwives.

BACKGROUND: Most proposals to increase access to primary care in the United States emphasize increasing the proportion of generalist physicians. Another approach is to increase the number of physician assistants, nurse practitioners, and certified nurse-midwives. METHODS: We analyzed variations in the regulation of nurse practitioners, physician assistants, and certified nurse-midwives in all 50 states and the District of Columbia. Using a 100-point scoring system, we assigned numerical values to specific characteristics of the practice environment in each state for each group of practitioners, awarding a maximum of 20 points for legal status, 40 points for reimbursement for services, and 40 points for the authority to write prescriptions. We calculated coefficients for the correlation of summary measures of these values within states with estimates of the supply of practitioners per 100,000 population. RESULTS: There was wide variation among states in both practice-environment scores and practitioner-to-population ratios for all three groups of practitioners. We found positive correlations within states between the supply of physician assistants, nurse practitioners, and certified nurse-midwives and the practice-environment score for the state (Spearman rank-correlation coefficients, 0.63 [P < 0.001], 0.41 [P = 0.003], and 0.51 [P < 0.001], respectively). Positive associations were also found in the states between the supply of generalist physicians and the supply of physician assistants (r = 0.54, P < 0.001) and nurse practitioners (r = 0.35, P = 0.014). Nevertheless, in the 17 states with the greatest shortages of primary care physicians, favorable practice-environment scores were still associated with higher practitioner-to-population ratios for physician assistants (r = 0.68, P = 0.003), nurse practitioners (r = 0.54, P = 0.026), and certified nurse-midwives (r = 0.42, P = 0.09). CONCLUSIONS: State regulation of physician assistants, nurse practitioners, and certified nurse-midwives varies widely. Favorable practice environments are strongly associated with a larger supply of these practitioners.

Discharges from nursing homes: 1985 National Nursing Home Survey.

Statistics are presented on the characteristics of persons discharged from nursing homes over a 12-month period during 1984-85. Data are presented on discharge status (live or dead), duration of stay, dependencies in mobility and continence, living arrangements (prior to admission and after discharge), primary diagnoses at admission and discharge, primary sources of payment for admission and discharge months, histories of other institutionalizations according to sex and age, marital status at discharge, race, and Hispanic origin. Also presented is information on nursing home discharges by facility characteristics including ownership status, bed size, chain affiliation, and whether the nursing home was in a metropolitan statistical area.