Elsevier

Nursing Outlook

Volume 65, Issue 6, November–December 2017, Pages 689-696
Nursing Outlook

Article
Practice
Call to action: APRNs in U.S. nursing homes to improve care and reduce costs

https://doi.org/10.1016/j.outlook.2017.08.011Get rights and content

Highlights

  • Missouri Quality Initiative (MOQI) has been successful in reducing hospitalizations and expenditures for long-stay nursing home residents.

  • MOQI implemented interprofessional model in long-term care facilities with advanced practice registered nurses (APRNs) at the forefront.

  • The success of the MOQI model reinforces decades of research demonstrating that care provided by APRNs is cost-effective, safe, and associated with positive health outcomes and patient satisfaction.

  • Changes in regulations are necessary to improve patient access to care and encourage the use of APRNs in nursing homes nationwide.

Abstract

Background

Centers for Medicare and Medicaid Innovation Center sponsored the initiative to reduce avoidable hospitalizations among nursing facility residents.

Purpose

Missouri Quality Initiative (MOQI) designed inter-professional model in nursing homes with advanced practice registered nurses (APRNs).

Method

MOQI APRN model was implemented for 4 years in 16 nursing homes in a metro area of the Midwest. Hospitalizations were reduced (40% all-cause, 58% potentially avoidable), emergency room visits (54% all-cause, 65% potentially avoidable), Medicare expenditures for hospitalizations (34% all-cause, 45% potentially avoidable), and Medicare expenditures for emergency room visits (50% all-cause, 60% potentially avoidable) for long-stay nursing home residents.

Discussion

Success of the MOQI model reinforces decades of research demonstrating that care provided by APRNs is cost-effective, safe, and associated with positive health outcomes and patient satisfaction.

Conclusion

Nursing homes can implement and benefit by hiring APRNs. However, changes in the Code of Federal Regulation (CFR 483.40) are necessary to improve patient access to care and encourage hiring APRNs in US nursing homes.

Section snippets

APRN Quality of Care

Researchers have investigated the quality of care provided by APRNs since the 1970s. Although much of the research is dated, the span of publications reinforces how APRNs have consistently provided safe and effective care over the past 40 years in the United States. Most of the research demonstrates that care provided by physicians and nurse practitioners result in similar favorable health outcomes (Horrocks et al., 2002, Laurant et al., 2005, Lentz et al., 2004, Newhouse et al., 2011, Sackett

APRNs in Long-Term Care in the United States

Studies on APRN practice in LTC facilities concur with those discussed above indicating that APRNs maintain physician, resident, and family satisfaction (Rosenfeld, Kobayashi, Barber, & Mezey, 2004), contribute to the reduction in hospitalization and emergency room visits (Burl et al., 1994, Burl et al., 1998), and are associated with positive health outcomes of facility residents (Burl et al., 1998, Ryan, 1999). The results of the first 3 years of the MOQI intervention reaffirms these

Conclusion

APRNs have a proven record of providing safe, therapeutic, and cost-effective care to their patients in the United States (Aigner et al., 2004, Horrocks et al., 2002, Laurant et al., 2005, Lentz et al., 2004, Newhouse et al., 2011, Oliver et al., 2014, Sackett et al., 1974, Swan et al., 2015, Venning et al., 2000). MOQI capitalizes on the expertise of APRNs by providing a full-time APRN in each of 16 NFs in Missouri in an effort to meet the goals of CMS' Initiative to Reduce Avoidable

Acknowledgments

This project is supported by grant number 1E1CMS331080 from the Centers for Medicare and Medicaid Innovations Center and Medicare Medicaid Coordination Office. The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is focused on improving care and outcomes for Medicare–Medicaid enrollees residing in nursing facilities (http://innovation.cms.gov/initiatives/rahnfr/). The content is solely the responsibility of the authors and does not represent the official views of

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      There is a wealth of literature that indicates primary care and LTC APRNs have similarly favorable outcomes as physicians (Horrocks et al., 2002; Laurant et al., 2005; Lentz et al., 2004; Newhouse et al., 2011; Sackett et al., 1974; Swan et al., 2015), comparable prescribing practices as physicians (Horrocks et al., 2002; Venning et al., 2000), and similar rates of emergency room referrals and hospitalizations as physicians (Burl et al., 1994; Burl et al., 1998; Newhouse et al., 2011). APRNs have contributed to enhanced quality of life and improved health outcomes of LTC residents, including the reduction in polypharmacy and inappropriate use of psychotropic medications (Burl et al., 1998; Rantz et al., 2017; Ryan, 1999). APRNs tend to have longer and more frequent patient visits than physicians (Horrocks et al., 2002; Kinnersley et al., 2000), which may contribute to greater patient satisfaction as repeatedly reported (Laurant et al., 2005; Lentz et al., 2004; Rosenfeld, Kobayashi, Barber, & Mezey, 2004; Swan et al., 2015; Venning et al., 2000).

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