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Research Letter
July 10, 2017

Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014

Author Affiliations
  • 1Cambia Palliative Care Center of Excellence, University of Washington, Seattle
  • 2Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island
  • 3Hebrew SeniorLife Institute for Aging Research and Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. Published online July 10, 2017. doi:10.1001/jamainternmed.2017.2136

Residents of nursing homes (NHs) comprise a medically complex and vulnerable population with many persons experiencing multiple comorbid conditions, frailty, and advanced dementia. Health care professionals such as physicians, nurse practitioners (NPs), and physician assistants (PAs) play an important role in managing their care. An Office of Inspector General Report1 noted that specialization of health care professionals in NH care could potentially improve care through increased presence of health care professionals in NHs, enhanced knowledge in the care of patients with medically complex conditions, and better understanding of the regulatory environment. On the contrary, specialization in 1 setting of care could result in increased fragmentation of care, giving rise to concerns about medical errors and lack of care coordination. Little empirical research is available about the number of clinicians who primarily practice in NHs or the proportion of NH care delivered by these clinicians.2 Using national Medicare Part B claims from 2007, 2010, and 2014, we characterized temporal trends in the number of physicians, NPs, and PAs concentrating their practice in the NH or skilled nursing facility (SNF) setting (ie, SNFists), the fraction of all NH and SNF claims generated by SNFists, and state variation in this phenomenon in 2014.

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