The association between access to medical care (physicians and nurse practitioners) and impact on resident outcomes: A retrospective cross-sectional analysis

  • Author / Creator
    Bali, Krittika
  • The nursing home population is vulnerable and medically complex, yet little is known about models of medical service provision and associated quality outcomes. The goal of this thesis project is to examine the association between physician and nurse practitioner accessibility and practice sensitive outcomes. This project used data from the Translating Research in Elder Care (TREC) longitudinal study and the routinely collected Resident Assessment Instrument – Minimum Data Set version 2.0 (RAI-MDS 2.0) to test the association between the availability of physicians (MD) and nurse practitioners (NP) in nursing homes (NH) and clinically-relevant resident outcomes of antipsychotic medication (APM) use without indication of psychosis, physical restraint use,
    hospitalization and emergency department (ED) transfers, and polypharmacy. Eight models were created using logistic regression to test the association between the access measures of daily presence of MD or NP on unit and MDs being involved in care planning and each of the four resident outcomes. The sample consisted of 10,888 residents across 320 units in 92 facilities. Staff from 277 (86%) units reported an MD or NP visited daily and 318 (99%) units reported that the MD or NP could be reached when needed. Following adjustment for multiple confounding variables, there were no associations between either measure of access and any of the resident outcomes. For example, the association between having an NP visit the unit on a typical weekday and APM use
    (OR= 1.18, 95% CI: 0.56-2.53), NP presence on a unit on a typical weekday and physical restraint use among residents (OR=2.08, 95% CI: 0.26-2.10) and MDs (OR=1.42, 95% CI: 0.54-3.75) should be noted for having wide confidence intervals. Associations between having visits with either an MD or NP at the unit level and hospitalization and ED transfers (OR=1.17, 95% CI: 0.46-3.10) and polypharmacy and visits by either NP or MD (OR=1.37, 95% CI: 0.64-2.93) follow the same trend. There were wide 95% confidence intervals for all estimates of association. Although no associations were identified between these medical care access measures and the selected resident outcomes, the wide confidence intervals demonstrate uncertainty on the point estimates. Additional research with more direct measures of access to medical care is still needed.

  • Subjects / Keywords
  • Graduation date
    Spring 2022
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.