Abstract
Introduction:
There is a high level of clinical need among residents but little is known about the role of physicians or nurse practitioners (NP) in the nursing home (NH) setting. Our objective was to test for associations between physician and nurse practitioner (NP) presence on care units and outcomes among nursing home (NH) residents. A retrospective cross sectional analysis of secondary data collected in the Translating Research in Elder Care (TREC) study during 2019-20. The sample consisted of 10,888 residents across 320 care units in 92 facilities.
Methods:
We used TREC Survey data (which included items on daily presence of physicians and NPs on units, physician involvement in care planning, and ability to contact physician or NP when necessary) linked to routinely collected Resident Assessment Instrument – Minimum Data Set version 2.0 (RAI-MDS 2.0), which included the outcomes antipsychotic medication (APM) use without indication, physical restraint use, hospital transfers, and polypharmacy. Eight logistic regression models were created to test the association between measures of daily presence of physician or NP on unit and physician involvement in care planning and each outcome.
Results:
Of the 320 sampled units, 277 (86%) reported a physician or NP visited daily, 160 (72.1%) units reported that the resident’s physician was involved in care planning, and 318 (99%) units reported that the physician or NP could be reached when needed. Following adjustment for multiple confounding variables, there were no associations between presence of medical professional and any resident outcome. There was no association between either physician or NP presence on the unit and hospitalization and ED transfers (AOR=1.17, 95% CI: 0.46-3.10) or polypharmacy (AOR=1.37, 95% CI: 0.64-2.93).
Conclusions:
No association was found between any of the medical care provider presence measures and resident outcomes. This was surprising given the existing, but limited, research