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Background: New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. Purpose: To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. Methods: A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition–related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. Results: As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p =.007; β = −2.218; 95% confidence interval [CI]: −3.79 to −0.644 and p =.04; β = −2.698; 95% CI: −5.268 to −0.127, respectively). Implications for practice: Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries. [ABSTRACT FROM AUTHOR]

Background: Prevalence of electronic health records (EHRs) has significantly increased, and EHRs are a known contributor to clinician burnout. However, it is unknown whether the use of multifunctional EHRs is associated with nurse practitioner (NP) burnout in primary care practices. This is a major gap in the literature because 69% of practicing NPs deliver primary care services to patients. Purpose: This study aimed to investigate whether the use of multifunctional EHRs is associated with primary care NP burnout. Method: This study is a secondary analysis of cross-sectional survey data collected from NPs in two states (Pennsylvania and New Jersey). Nurse practitioners completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Use of multifunctional EHRs was operationalized using two items—computerized capabilities and electronic reminder systems. Burnout was measured using a validated, single item asking NPs to self-report their feelings of burnout. A multilevel cox regression model was built to test for associations between the use of multifunctional EHRs and NP burnout. Results: Of 396 NPs included, 25.3% reported burnout. The use of multifunctional EHRs did not increase primary care NP burnout (risk ratio = 0.30, 95% confidence interval = 0.13–0.71, p =.01). Implications for practice: With 25.3% of NPs burned out, it is imperative to reduce NP burnout. However, computerized capabilities and electronic reminder systems did not contribute to feelings of NP burnout. Future research examining other EHR components is needed to understand which features of the EHR contribute to NP burnout. [ABSTRACT FROM AUTHOR]