Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis.

UNLABELLED: BACKGROUND: Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. METHODS: This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician). RESULTS: NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. CONCLUSIONS: This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.

The medical malpractice insurance "crises" and federal medical malpractice tort reform: Collection and analysis of bills passed by the United States House of Representatives from 1995--2005

There have been three medical malpractice insurance "crises" in the United States over a time spanning roughly the past three decades (Poisson, 2004, p. 759-760). Each crisis is characterized by a number of common features, including rapidly increasing medical malpractice insurance premiums, cancellation of existing insurance policies, and a decreased willingness of insurers to offer or renew medical malpractice insurance policies (Poisson, 2004, p. 759-760). Given the recurrent "crises," many sources argue that medical malpractice insurance coverage has become too expensive a commodity—one that many physicians simply cannot afford (U.S. Department of Health and Human Services [HHS], 2002, p. 1-2; Physician Insurers Association of America [PIAA], 2003, p. 1; Jackiw, 2004, p. 506; Glassman, 2004, p. 417; Padget, 2003, p. 216). ^ The prohibitively high cost of medical liability insurance is said to limit the geographical areas and medical specializations in which physicians are willing to practice. As a result, the high costs of medical liability insurance are ultimately said to affect whether or not people have access to health care services. ^ In an effort to control the medical liability insurance crises—and to preserve or restore peoples' access to health care—every state in the United States has passed "at least some laws designed to reduce medical malpractice premium rates" (GAO, 2003, p.5-6). More recently, however, the United States has witnessed a push to implement federal reform of the medical malpractice tort system. Accordingly, this project focuses on federal medical malpractice tort reform. This project was designed to investigate the following specific question: Do the federal medical malpractice tort reform bills which passed in the House of Representatives between 1995 and 2005 differ in respect to their principle features? To answer this question, the text of the bills, law review articles, and reports from government and private agencies were analyzed. Further, a matrix was compiled to concisely summarize the principle features of the proposed federal medical malpractice tort reform bills. Insight gleaned from this investigation and matrix compilation informs discussion about the potential ramifications of enacting federal medical malpractice tort reform legislation. ^

HEAD OF HOUSEHOLD STRUCTURE: ITS INFLUENCE ON THE DIETARY QUALITY OF U.S. HOUSEHOLDS, 1977-78 (UNITED STATES, NATIONWIDE FOOD CONSUMPTION SURVEY)

Using analysis of variance, household data collected in the Spring portion of the 1977-78 Nationwide Food Consumption Survey conducted by the United States Department of Agriculture were analyzed to examine the relationship between household characteristics and dietary quality of the household food supply. Results indicated that head of household structure was a statistically significant variable, with female headed households having higher dietary quality.^ Further analysis indicated that neither race, degree of urbanization, regional location, the education level of the female head, nor her employment status were significant variables in influencing dietary quality. The influence of head of household structure remained significant when these variables were controlled. However, income, household size, and family life cycle stage had statistically significant effects on dietary quality, and when individually controlled, the influence of head of household structure disappeared. ^

Distance Education and the Evolution of Online Learning in the United States

Online education is no longer a trend, rather it is mainstream. In the Fall of 2012, 69.1% of chief academic leaders indicated online learning was critical to their long-term strategy and of the 20.6 million students enrolled in higher education, 6.7 million were enrolled in an online course (Allen & Seaman, 2013; United States Department of Education, 2013). The advent of online education and its rapid growth has forced academic institutions and faculty to question the current styles and techniques for teaching and learning. As developments in educational technology continue to advance, the ways in which we deliver and receive knowledge in both the traditional and online classrooms will further evolve. It is necessary to investigate and understand the progression and advancements in educational technology and the variety of methods used to deliver knowledge to improve the quality of education we provide today and motivate, inspire, and educate the students of the 21st century. This paper explores the atioevolution of distance education beginning with correspondence and the use of parcel post, to radio, then to television, and finally to online education.

Index of all reports issued by Bureaus of Labor Statistics in the United States, prior to March 1, 1902

prepared under the direction of Carroll D. Wright ; for the use of the United States Department of Labor.

Nomination of Robert B. Pirie, Jr. : hearing before the Subcommittee on Manpower and Personnel of the Committee on Armed Services, United States Senate, Ninety-sixth Congress, first session, on the nomination of Robert B. Pirie, Jr., to be Assistant Secretary of Defense for Manpower, Reserve Affairs, and Logistics, April 6, 1979.

Mode of access: Internet.

Comprehensive health planning as carried out by State and areawide agencies in three States, Department of Health, Education, and Welfare; report to the Congress,

"B-164031(2)."

Settlement of the Dollar Line case. A report by the Secretary of the Commerce to the President of the United States, December 1952.

Mode of access: Internet.

The law of treaties as applied by the government of the United States of America.

Mimeographed.

Report to the President of the United States by the Economic Survey Mission to the Philippines.

"October 9, 1950."

Official register of the United States.

Mode of access: Internet.

Public health personnel in the United States, 1980 : second report to the Congress of the Secretary of Health and Human Services as required by section 793 of the Public Health Service Act.

Mode of access: Internet.

Navigation laws of the United States.

Mode of access: Internet.

Hearings on H.R. 2637, to amend title 10, United States Code, to authorize the Secretary of the Air Force to contract with air carriers ... and the posture of the U.S. military airlift before the Committee on Armed Services, House of Representatives, Ninety-fifth Congress, first session, September 19, 20, 1977.

Mode of access: Internet.

Drug trafficking : a report to the President of the United States /

"August 3, 1989."