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.

Message from the President of the United States, transmitting documents relative to the commencement and progress of any acts or system of retaliation upon prisoners of war, by the Governments of Great Britain and the United States. --

13th Congress, 3d session. House. Doc. no. 13.

Message from the President of the United States, transmitting communications from the plenipotentiaries of the United States charged with negotiating peace with Great Britain : showing the conditions on which alone that government is willing to put an end to the war. --

13th Congress, 3d session. House. Doc. 6.

Message from the President of the United States, transmitting copies of the instructions given to the ministers of the United States appointed to negotiate a peace with Great Britain. --

13th Congress, 3d session. House. Doc. no. 8.

Message from the President of the United States, transmitting a report of the Secretary of State, in obedience to a resolution of the thirteenth inst. "requesting the President to lay before this House such documents relative to the Russian mediation as in his opinion it may not be improper to communicate." --

United States,13th Congress, 2d session, 1813-1814. House. Doc. no. 35.

Message from the President of the United States to both Houses of Congress at the commencement of the second session of the twelfth Congress. --

November 4, 1812. Read, and ordered to be printed.

Report of the Committee to whom was Referred the Correspondence between Mr. Monroe and Mr. Canning, and between Mr. Madison and Mr. Rose, relative to the attacked of Chesapeake : and also a communication from the President of the United States of the 30 March last, with a letter from Mr. Erskine to the Secretary of State, and a letter from M. Champagny to Gen. Armstrong.--

April 16, 1808. Printed by Order of the Senate.

Message from the President of the United States to both Houses of Congress at the commencement of the second session of the twelfth Congress

November 4, 1812. Read, and ordered to be printed. Includes Documents accompanying the Message of the President of the United States to the two Houses of Congress, at the opening of the second session of the twelfth Congress United States. 12th Congress, 2nd session, 1812-1813. House.; United States. 12th Congress, 2nd session, 1812-1813. Senate.; United States. Congress. House.; United States. Congress. Senate. Printed by A. and C. Way

Message from the President of the United States, transmitting a report of the Secretary of State, in obedience to a resolution of the thirteenth inst.

Full Title: 47. Message from the President of the United States, transmitting a report of the Secretary of State, in obedience to a resolution of the thirteenth inst. "requesting the President to lay before this House such documents relative to the Russian mediation as in his opinion it may not be improper to communicate." United States,13th Congress, 2d session, 1813-1814. House. Doc. no. 35. January 18, 1814. Ordered to lie on the table. One letter in French with English translation Printed by Roger C. Weightman

Message from the President of the United States, transmitting communications from the plenipotentiaries of the United States charged with negotiating peace with Great Britain

Full Title: Message from the President of the United States, transmitting communications from the plenipotentiaries of the United States charged with negotiating peace with Great Britain : showing the conditions on which alone that government is willing to put an end to the war 13th Congress, 3d session. House. Doc. 6. October 10, 1814. Referred to the Committee of Foreign Relations. Printed by Roger C. Weightman

Message from the President of the United States, transmitting copies of the instructions given to the ministers of the United States appointed to negotiate a peace with Great Britain

13th Congress, 3d session. House. Doc. no. 8. -------------------------------------------------------------------------------- October 14, 1814. Read and referred to the Committee of Foreign Relations. Printed by Roger C. Weightman

Message from the President of the United States, transmitting documents relative to the commencement and progress of any acts or system of retaliation upon prisoners of war, by the Governments of Great Britain and the United States

13th Congress, 3d session. House. Doc. no. 13. October 28, 1814. Read, referred to the Committee on Foreign Relations. Printed by A. and G. Way

Vignettes and self-reported work disability in the United States: Correction of report heterogeneity

Subjective measures of health tend to suffer from bias given by reporting heterogeneity. however, some methodologies are used to correct the bias in order to compare self-assessed health for respondents with different sociodemographic characteristics. One of the methods to correct this is the hierarchical ordered probit (hopit), which includes rates of vignettes -hypothetical individuals with a fixed health state- and where two assumptions have to be fulfilled, vignette equivalence and response consistency. this methodology is used for the self-reported work disability for a sample of the united states for 2011. The results show that even though sociodemographic variables influence rating scales, adjusting for this does not change their effect on work disability, which is only influenced by income. the inclusion of variables related with ethnicity or place of birth does not influence the true work disability. however, when only one of them is excluded, it becomes significant and affects the true level of work disability as well as income.

General index to the published volumes of the Diplomatic correspondence and Foreign relations of the United States. 1861-1899.

Published in accordance with the Sundry civil act of June 6, 1900.

Foreign relations of the United States, 1955-1957.

Includes bibliographical references and index.