A framework of the institutional policies and practice environments of nurse practitioner primary care models: A cross-case analysis. Issue 4 (16th October 2022)

• Record Type: Journal Article
• Authors: Hogan, Tory H.; Maurer, Nicholas R.; Stevens, Lena; Hefner, Jennifer L.
• Is Part Of: Health care management review. Volume 47:Issue 4(2022)
• Page Start: 369
• Page End: 379
• Publication Date: 2022-10-16
• Subjects: Conceptual model -- nurse practitioners -- practice management -- primary care; Health services administration -- Periodicals; 362.1068
• DOI: 10.1097/HMR.0000000000000344
• Languages: English
• ISSNs: 0361-6274

Abstract

Abstract : Purpose: The purpose of this article was to compare the implementation of distinct models of nurse practitioner (NP) integration into primary care offices. Design/Methodology: A multiple case study design of three NP primary care practice models allowed for in-depth exploration of the management processes supporting the utilization of NPs. At each site, semistructured qualitative interviews, document review, and site tours/observations were conducted and subject to cross-case analysis guided by the NP Primary Care Organizational Framework (NP-PCOF)—developed for this study based on existing theory. Results: Our case study sites represent three distinct NP primary care models. In the restricted practice model, NPs care for same-day/walk-in acute patients. NPs in the independent practice model have an independent panel of patients and interact collegially as independent coworkers. NPs in the comanagement model function on a team (a physician and two NPs), have a team office space, collectively care for a shared panel of patients, and can earn financial bonuses contingent upon meeting team quality metrics. Our cross-case analysis confirmed differences in physical space design, the relational structure of a workplace, and the capacity for innovation via NP compensation and performance metrics across different NP primary care models. Conclusion: Our findings suggest that NP primary care models are supported by complex management systems and the NP-PCOF is a tool to help understand this complexity. Implications: The NP-PCOF is a framework to understand the management systems that facilitate the utilization of NPs within primary care organizations.