Understanding Why Nurse Practitioner (NP) and Physician Assistant (PA) Productivity Varies Across Community Health Centers (CHCs): A Comparative Qualitative Analysis. (February 2021)

• Record Type: Journal Article
• Authors: Pittman, Patricia; Park, Jeongyoun; Bass, Emily; Luo, Qian "Eric"
• Other Names: Washko Michelle guest-editor.; Spetz Joanne guest-editor.
• Is Part Of: Medical care research and review. Volume 78:Number 1(2021)Supplement
• Page Start: 18S
• Page End: 29S
• Publication Date: 2021-02
• Subjects: nurse practitioners -- physician assistants -- primary care -- community health centers -- workforce -- productivity -- production function -- qualitative comparative analysis; Medical care -- United States -- Periodicals; Medical care -- Periodicals; Medical care -- Research -- United States -- Periodicals; Medical care -- Research -- Periodicals; Medical economics -- United States -- Periodicals; Medical economics -- Periodicals; 362.10973
• DOI: 10.1177/1077558720960893
• Languages: English
• ISSNs: 1077-5587

Abstract

This study asks how much and why the productivity of advanced practice clinicians (APCs; nurse practitioners and physician assistants) varies across community health centers (CHCs), as measured in their marginal contribution to overall patient visits. We found APCs in the 90th percentile CHCs provide about 1, 840 adjusted-visits per year, whereas APCs in the 10th percentile CHCs provide about 978 adjusted-visits per year. We interviewed leadership at 14 high APC and 16 low APC productivity CHCs to elicit organizational conditions that could explain the difference. Using content analysis and then qualitative comparative analysis, we found several important conditions were more common among high productivity CHCs, including scheduling APCs and physicians for the same number of visits, parity in terms of any financial incentives, and formal education programs for new APCs during onboarding/transition to practice.