Optimal Staffing Models To Care For Frail Older Adults In Primary Care And Geriatrics Practices In The US

Different staffing configurations in primary and geriatric care practices could have implications for how best to deliver services that are essential for a growing population of older adults. Using data from a 2018 survey of physicians (MDs) and nurse practitioners (NPs) working in primary and geria...

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Bibliographic Details
Published in:Health affairs (Millwood, Va.) Va.), 2021-09, Vol.40 (9), p.1368-3
Main Authors: Auerbach, David I, Levy, Douglas E, Maramaldi, Peter, Dittus, Robert S, Spetz, Joanne, Buerhaus, Peter I, Donelan, Karen
Format: Article
Language:English
Subjects:
Activities of daily living
Adults
Chronic illnesses
Configurations
Costs
COVID-19
Dementia
Doctors' assistants
Employment
Frail
Frailty
Geriatrics
Health care
Health care policy
Labor costs
Medical personnel
Medical practices
Medicare
Nurse practitioners
Older people
Patients
Physicians
Population
Primary care
Probability
Quality of care
Questionnaires
Services
Social workers
Staffing
Teams
Workforce planning
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Summary:Different staffing configurations in primary and geriatric care practices could have implications for how best to deliver services that are essential for a growing population of older adults. Using data from a 2018 survey of physicians (MDs) and nurse practitioners (NPs) working in primary and geriatric care, we assessed whether different configurations were associated with better or worse performance on a number of standard process measures indicative of comprehensive, high-quality primary care. Practices with a large concentration of MDs had the highest estimated labor costs. Practices high in NPs and physician assistants (PAs) were most common in states that grant full scope of practice to NPs. The high-NP/PA configuration was associated with a 17-percentagepoint greater probability of facilitating patient visits and a 26-percentagepoint greater probability of providing the full bundle of primary care services compared with the high-MD model. Team-based configurations had a 27.7-percentage-point greater probability of providing the full bundle of primary care services. The complex needs of older adults may be best served by team-based practices with a broad provider mix that can provide a range of services in the office and the community.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2021.00401