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Nurse Practitioner Practice Environments in Primary Care and Quality of Care for Chronic Diseases

Poghosyan, Lusine, PhD, MPH, RN, FAAN*; Norful, Allison A., PhD, RN, ANP-BC*; Liu, Jianfang, PhD*; Friedberg, Mark W., MD

doi: 10.1097/MLR.0000000000000961
Original Articles

Background: The chronic disease burden in the United States represents a significant challenge for the primary care system. The nurse practitioner (NP) workforce can help meet the demand for care; however, organizational barriers such as poor practice environments prevent NPs from delivering high quality care.

Objectives: We investigated the relationship between NP practice environments and quality of care for chronic diseases.

Research Design: We fit regression models to assess cross-sectional associations between claims-based quality measure performance and survey data on NP practice environments in Massachusetts.

Subjects: We used survey data from 221 primary care NPs from 118 practices. We obtained quality of care data for patients with asthma, diabetes, and cardiovascular disease.

Measures: The Nurse Practitioner Primary Care Organizational Climate Questionnaire was used to measure practice environments with its following 4 subscales: NP-Physician Relations, Independent Practice and Support, Professional Visibility, and NP-Administration Relations. Three Healthcare Effectiveness Data and Information Set measures were used to evaluate the quality of care.

Results: A 1-SD increase in the organizational-level NP-Administration Relations subscale score was associated with a near doubling of the odds of receiving medication management for asthma. A 1-SD increase in the organizational-level Independent Practice and Support subscale score was associated with a 60% increase in the odds of receiving recommended screening for cardiovascular disease. There was no impact on diabetes care measure.

Conclusions: NP practice environment affected the quality of care for 2 chronic conditions. Efforts should be implemented to improve NP practice environment to potentially improve care quality.

*Columbia University School of Nursing, New York, NY

RAND Boston, Boston, MA

Supported by the Agency for Healthcare Research and Quality [R03HS020999], Robert Wood Johnson Foundation, and the National Institutes of Health [TL1TR001875].

The authors declare no conflict of interest.

Reprints: Lusine Poghosyan, PhD, MPH, RN, FAAN, Columbia University School of Nursing, 560 W. 168th Street, Office 603, New York, NY 10032. E-mail: lp2475@cumc.columbia.edu.

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