2.50
Hdl Handle:
http://hdl.handle.net/10755/158220
Type:
Presentation
Title:
Predicting patient retention in NP primary care practices
Author(s):
Lenz, Elizabeth
Author Details:
Elizabeth Lenz, PhD, Associate Dean at Columbia University, New York, NY, USA, email: erl13@columbia.edu [updated contact info: lenz.23@osu.edu]
Abstract:
Statement of the Problem. The ability of a primary care practice to retain enrollees is essential to its financial viability, and is one of the commonly cited indicators of quality. Theoretically, satisfaction is a major determinant of patients' decisions about whether to remain with a practice. However, other factors including insurance and employment status, employer-initiated changes in health care benefits, geographical moves and perceived need for health care may constrain patients' choices, regardless of their satisfaction levels. This study identified and compared predictors of 1-year and 2-year patient retention in two newly established, urban NP-run primary care practices: an ambulatory primary care clinic serving primarily Hispanic immigrants, and a commercially insured practice serving predominantly middle-class Caucasians. Samples. Two samples were analyzed. The first included all 806 patients enrolled in the primary care clinic upon referral from an emergency room. This sample averaged 45.5 years of age, was 75.9 % female, 85.1% Hispanic and 86.7% Medicaid-insured. The second sample was comprised of all 470 patients who enrolled in the primarily commercially insured practice between September 1997 and August 1999. Sample characteristics were average age of 43.3 years, 83.6% female, 64.7% college-educated and 88.3% insured. Methods. This method was a secondary analysis of data from three sources. Data for the 709 patients in the primary care clinic were collected during a randomized study comparing nurse practitioner and physician patient outcomes; only the nurse practitioner practice patients were included in this analysis. Predictors, measured at the time of the initial visit to the practice, included demographic characteristics, health status (SF-36 scores, and diagnosis of hypertension, diabetes, and/or asthma), satisfaction with initial visit, and Medicaid status. The outcomes, obtained from hospital billing data, were 1-year retention (at least one visit in the 12 months following the initial visit) and 2-year retention (at least one visit 12-24 months following the initial visit). Data for the patients in the commercially insured practice were obtained from being female patient intake forms, charts and billing records. No satisfaction or SF-36 data were available for the commercially insured practice sample. Data were analyzed using logistic regression (SPSS). Results. In the clinic sample, the strongest predictor of 1-year retention was insurance (those with Medicaid were 3.2 times more likely to have at least one follow-up visit than those without). The only other predictor of 1-year retention was having one of the three chronic conditions. Insurance remained the strongest predictor of long-term retention (Medicaid patients 9.6 times more likely to have had at least one follow-up visit during year 2). Other significant, but weak predictors included older age and one of the target conditions. Neither health status nor baseline satisfaction predicted retention. In the commercially insured sample, the predictors of 1-year retention were having insurance, stating that friendly personnel were the reason for choosing the practice, and female gender. The only predictor of 2-year retention was insurance status. Conclusion. Insurance is the only characteristic that consistently predicted retention in NP primary care practices serving very two different populations. The findings call into question the use of satisfaction as an indicator of quality in primary care.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Conference Date:
2001
Conference Host:
Western Institute of Nursing
Conference Location:
Seattle, Washington, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePredicting patient retention in NP primary care practicesen_GB
dc.contributor.authorLenz, Elizabethen_GB
dc.author.detailsElizabeth Lenz, PhD, Associate Dean at Columbia University, New York, NY, USA, email: erl13@columbia.edu [updated contact info: lenz.23@osu.edu]en_GB
dc.identifier.urihttp://hdl.handle.net/10755/158220-
dc.description.abstractStatement of the Problem. The ability of a primary care practice to retain enrollees is essential to its financial viability, and is one of the commonly cited indicators of quality. Theoretically, satisfaction is a major determinant of patients' decisions about whether to remain with a practice. However, other factors including insurance and employment status, employer-initiated changes in health care benefits, geographical moves and perceived need for health care may constrain patients' choices, regardless of their satisfaction levels. This study identified and compared predictors of 1-year and 2-year patient retention in two newly established, urban NP-run primary care practices: an ambulatory primary care clinic serving primarily Hispanic immigrants, and a commercially insured practice serving predominantly middle-class Caucasians. Samples. Two samples were analyzed. The first included all 806 patients enrolled in the primary care clinic upon referral from an emergency room. This sample averaged 45.5 years of age, was 75.9 % female, 85.1% Hispanic and 86.7% Medicaid-insured. The second sample was comprised of all 470 patients who enrolled in the primarily commercially insured practice between September 1997 and August 1999. Sample characteristics were average age of 43.3 years, 83.6% female, 64.7% college-educated and 88.3% insured. Methods. This method was a secondary analysis of data from three sources. Data for the 709 patients in the primary care clinic were collected during a randomized study comparing nurse practitioner and physician patient outcomes; only the nurse practitioner practice patients were included in this analysis. Predictors, measured at the time of the initial visit to the practice, included demographic characteristics, health status (SF-36 scores, and diagnosis of hypertension, diabetes, and/or asthma), satisfaction with initial visit, and Medicaid status. The outcomes, obtained from hospital billing data, were 1-year retention (at least one visit in the 12 months following the initial visit) and 2-year retention (at least one visit 12-24 months following the initial visit). Data for the patients in the commercially insured practice were obtained from being female patient intake forms, charts and billing records. No satisfaction or SF-36 data were available for the commercially insured practice sample. Data were analyzed using logistic regression (SPSS). Results. In the clinic sample, the strongest predictor of 1-year retention was insurance (those with Medicaid were 3.2 times more likely to have at least one follow-up visit than those without). The only other predictor of 1-year retention was having one of the three chronic conditions. Insurance remained the strongest predictor of long-term retention (Medicaid patients 9.6 times more likely to have had at least one follow-up visit during year 2). Other significant, but weak predictors included older age and one of the target conditions. Neither health status nor baseline satisfaction predicted retention. In the commercially insured sample, the predictors of 1-year retention were having insurance, stating that friendly personnel were the reason for choosing the practice, and female gender. The only predictor of 2-year retention was insurance status. Conclusion. Insurance is the only characteristic that consistently predicted retention in NP primary care practices serving very two different populations. The findings call into question the use of satisfaction as an indicator of quality in primary care.en_GB
dc.date.available2011-10-26T20:37:47Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:37:47Z-
dc.conference.date2001-
dc.conference.hostWestern Institute of Nursingen_GB
dc.conference.locationSeattle, Washington, USAen_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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