ArticleJournal of the American Medical Directors Association2025
Changes in Physician Workforce Composition and Rehospitalization From Post-Acute Care in Nursing Homes Between 2012 and 2019.
Article in Journal of the American Medical Directors Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesOver the past decade, US nursing home workforce experienced considerable growth among advanced practitioners (APs), particularly nurse practitioners. We measured the association between workforce composition and rehospitalization from post-acute care in the nursing home.
designCohort study using Medicare claims for 2012 and 2019. SETTING AND
participantsA total of 9171 nursing homes which provided post-acute care to Medicare fee-for-service beneficiaries in both 2012 and 2019. Hospital-based facilities were excluded.
methodsThe change in workforce composition over the study period was measured by calculating the percentages of visits performed by APs and physicians in generalist specialties and categorized into 5 groups: (1) any decrease in the percent of visits by Aps, (2) stable or small [<5 percentage point (ppt)] increase, (3) 5 to 40 ppt increase, (4) 41 to 70 ppt increase, and (5) >70 ppt increase in the proportion of visits performed by APs. Unplanned 30-day rehospitalization rates from post-acute care for each facility were measured using Medicare's quality measure specification. We estimated first-difference linear regression models to compare the rehospitalization rates between the 5 workforce composition categories, adjusting for nursing home characteristics.
resultsMost facilities increased the proportion of care provided by APs: 23% experienced a decrease (n = 2127), 19% remained stable (n = 1710), 33% increased by 5 to 40 ppt (n = 3030), 17% increased by 41 to 70 ppt (n = 1529), and 8% increased by >70 ppt (n = 775). Rehospitalization decreased in nursing homes with a relative increase in AP visits, but the association was statistically significant only for group 3 (5-40 ppt increase; 1.1% decrease in rehospitalizations; 95% CI, -1.8% to -0.4%; P = .003). CONCLUSIONS AND IMPLICATIONS: In this cohort study, a moderate shift in visits to APs was associated with a small but statistically significant decrease in rehospitalizations between 2012 and 2019. These findings support incorporation of APs into the nursing home workforce.
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