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Enhancing Nurse Practitioner Primary Care Delivery to Address Social Determinants of Health and Reduce Health Disparities: A mixed-methods national study

Award Number: R01NR021007
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 04/07/2023
PERIOD OF PERFORMANCE END DATE: 01/31/2027

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Enhancing Nurse Practitioner Primary Care Delivery to Address Social Determinants of Health and Reduce Health Disparities: A mixed-methods national study - More than 80% of adults aged 65 and older in the United States have at least one chronic health condition. Health disparities significantly affect care and outcomes for the chronically ill older adults, and many Black and Hispanic patients often lack high-quality care and use hospitals and emergency departments (EDs) for routine care. Where patients reside and receive care contributes to health disparities, and conditions of daily living lead to health disparities. Black and Hispanic patients also get care in low-quality healthcare settings. Health disparities will further widen due to primary care physician shortages. The growing nurse practitioner (NP) workforce can help reduce health disparities. Yet, practices employing NPs (i.e., NP practices) are often located in underserved communities and face major structural (e.g., lack of registries) and organizational (e.g., poor care environments) challenges. The study’s overarching aim is to understand ways in which NP practices could be leveraged to address conditions of daily living and reduce health disparities. Building on our prior work, we will conduct the first national mixed-methods study using multilevel models, geographic information system, and a positive-deviance approach to achieve the aims: Aim 1. Investigate the impact of conditions of daily living (i.e., economic stability, education, built environment, health care access, and social context) on health disparities in quality of care processes (e.g., HbA1c testing for diabetes) and outcomes (i.e., ED use, hospitalizations) among chronically older adults receiving care in NP practices. Aim 2. Assess the extent to which NP practice attributes (i.e., care environment, structural capabilities) moderate the impact of conditions of daily living on health disparities in quality of care processes and patient outcomes. Aim 3. Explore barriers and facilitators to addressing conditions of daily living and health disparities in NP practices with varying care environments and structural capabilities. We will use existing data on neighborhoods and chronically ill Medicare patients cared for by NPs in 2021-2022 in primary care practices (n=2,400). We will also survey NPs (n=6,960) in these practices on their care environments and structural capabilities using mail and online methods. All data about patients, neighborhoods, NPs, and practices will be merged and analyzed in multilevel models. We will also identify practices with favorable and unfavorable care environments and structural capabilities and interview NPs and practice managers using positive-deviance methods. We will conduct individual telephone/online interviews with ~50 NPs and ~50 practice managers from practices with favorable and ~35 NPs and ~35 managers from practices with unfavorable attributes. The interviews will be recorded and transcribed for content analysis. We will identify modifiable factors in practices to address conditions of daily living. Our quantitative and qualitative findings will be triangulated to inform administrators and policymakers seeking ways to leverage NP practices to address conditions of daily living and reduce health disparities through practice, policy, and neighborhood interventions.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $764,798 )
2026	2026	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Nursing Research	000	4	3/3/2026	NON-COMPETING CONTINUATION	$764,798
														Subtotal = $764,798

Issue Date FY: 2025 ( Subtotal = $797,149 )
2025	2025	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Nursing Research	001	3	8/26/2025	NON-COMPETING CONTINUATION	$79,715
2025	2025	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Nursing Research	000	3	2/14/2025	NON-COMPETING CONTINUATION	$717,434
														Subtotal = $797,149

Issue Date FY: 2024 ( Subtotal = $804,074 )
2024	2024	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Nursing Research	003	2	8/5/2024	NON-COMPETING CONTINUATION	$0
2024	2024	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Nursing Research	002	2	7/31/2024	NON-COMPETING CONTINUATION	$0
2024	2024	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Nursing Research	000	2	1/17/2024	NON-COMPETING CONTINUATION	$723,667
2024	2024	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Nursing Research	001	2	5/2/2024	NON-COMPETING CONTINUATION	$80,407
														Subtotal = $804,074

Issue Date FY: 2023 ( Subtotal = $758,740 )
2023	2023	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, THE	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Nursing Research	000	1	4/7/2023	NEW	$758,740
														Subtotal = $758,740

Grand Total All Awards = $3,124,761

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Enhancing Nurse Practitioner Primary Care Delivery to Address Social Determinants of Health and Reduce Health Disparities: A mixed-methods national study

Award Number: R01NR021007

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 04/07/2023

PERIOD OF PERFORMANCE END DATE: 01/31/2027

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