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.

Waste and financial management problems at the Air Force : hearing before the Committee on Governmental Affairs, United States Senate, One Hundred Second Congress, second session, February 19, 1992.

Shipping list no.: 92-0609-P.

Department of Defense inventory : why does the Pentagon buy so much? : hearing before the Subcommittee on Oversight of Government Management of the Committee on Governmental Affairs, United States Senate, One Hundred Second Congress, first session, March 11, 1992.

Shipping list no.: 93-0097-P.

Cost and management of nuclear safety and cleanup and compliance at Department of Energy defense sites [microform] : hearing before the Committee on Governmental Affairs, United States Senate, One Hundredth Congress, second session, Wednesday, July 13, 1988.

CIS Microfiche Accession Numbers: CIS 89 S401-10

Nomination of Harvey G. Ryland : hearing before the Committee on Governmental Affairs, United States Senate, One Hundred Third Congress, second session on nomination of Harvey G. Ryland to be Deputy Director, Federal Emergency Management Agency, September 20, 1994.

Shipping list no.: 95-0000-P.

Procurement irregularities associated with the Department of Defense's airborne self-protection jammer program : hearing before the Subcommittee on Federal Services, Post Office, and Civil Service of the Committee on Governmental Affairs, United States Senate, One Hundred Second Congress, second session, March 25, 1992.

Shipping list no.: 93-0170-P.

16th census of the United States: 1940. Census of business: 1939. Retail trade. Commodity sales: book stores; news dealers; stationery stores; gift, novelty, souvenir shops; office, store appliance and equipment dealers; office, store, school supply dealers; scientific, medical instrument and supply dealers.

At head of title: U.S. Dept. of Commerce. Jesse H. Jones, Secretary. Bureau of the Census. J.C. Capt, Director ..

Register of officers and agents, civil, military, and naval, in the service of the United States, on the ... : showing the state or territory from which each person was appointed to office, the state or country in which he was born, and the compensation, pay, and emoluments allowed to each; together with the names and compensation of all printers in any way employed by Congress, or any department or officer of the government.

Description based on: 1863.

Disapproving the recommendations of the Defense Base Closure and Realignment Commission : adverse report of the Committee on Armed Services, House of Representatives, on H.J. Res. 65, together with additional and dissenting views (including cost estimate of the Congressional Budget Office).

"September 29, 2005."

Decisions of the Interior Department in public land cases and land laws passed by the Congress of the United States [electronic resource] : together with the regulations of the General Land Office /

Vol. 2 has title: Land laws : regulations and decisions, being a continuation of acts of Congress respecting the sale and disposition of public lands and embracing land laws passed ... from December , 1859, to January 1, 1870

Effective Surface Water Quality Policies: A Contrast of Policies in the United States and the European Union

The United States and the European Union each have their own policy approach to protect surface water quality. Both policy approaches are similar in many ways. Both rely heavily on command and control. However, there are differences in the application of the details. Both the U.S. and E.U. began current efforts to protect surface water quality in the 1970s, yet quality continues to less than desired in both places. Both have reduced point source pollutants but have had difficulty controlling non-point source pollutants even though policies have been in place for many decades. The successes and failures of the two policies are studied in this project to determine which aspects of both policies will best protect surface water quality in an increasingly complex future.

Use of solar energy to heat anaerobic digesters : part I, technical and economic feasibility study : part II, economic feasibility throughout the United States /

Mode of access: Internet.

Impacts of sediment and nutrients on biota in surface waters of the United States /

"Grant no. R804868020."

Development of a model library microform center : submitted to United States Environmental Protection Agency, Library Systems Branch /

Mode of access: Internet.