Racial and ethnic disparities in ED use among older adults with asthma and primary care nurse practitioner work environments

TL;DR

The study finds that racial disparities in emergency department visits for older adults with asthma decrease when nurse practitioners work in better conditions.

Contribution

This study is the first to show that nurse practitioner work environments moderate racial disparities in ED use for asthma patients.

Findings

Black patients had fewer ED visits when NPs had favorable work environments.

Improved NP work environments reduced disparities in all-cause and ACSC ED visits.

Logistic regression confirmed the moderating effect of NP work environments on racial disparities.

Abstract

Nurse practitioners (NPs) increasingly deliver primary care in the United States. Yet, poor working conditions strain NP care. We examined whether racial/ethnic health disparities in ED visits among older adults with asthma are moderated by primary care NP work environments.

Survey data on NP work environments in six states were collected from 1,244 NPs in 2018–2019. 2018 Medicare claims data from 46,658 patients with asthma was merged with survey data to assess the associations of all-cause and ambulatory care sensitive conditions (ACSC) ED visits with NP work environment and race/ethnicity using logistic regression.

NP work environment moderated the association of race (Black patients versus White patients) with all-cause (odds ratio [OR]: 0.91; p-value = 0.045) and ACSC (OR: 0.90; p-value = 0.033) ED visits.

Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with favorable NP work environments.

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