University of Missouri - Saint Louis

The Graduate School


An oral examination in defense of the final project for the degree

Doctor of Nursing Practice

Patricia M. Sohn
BS in Nursing, December, 1991, Saint Louis University School of Nursing
MS in Nursing, May, 1998, Barnes-Jewish College of Nursing

The Role of the Nurse Practitioner in the Patient-Centered Medical Home



The Patient Centered Medical Home (PCMH) was established to improve patient access to high quality, cost-effective primary care. Critical to this new model of care is the optimal utilization of nurse practitioners (NPs) in performing services traditionally offered by physicians. This study compared the roles of NPs and physicians in providing primary care in two PCMHs in a local health care system.

During the calendar year 2011, a total of 50,471 patient visits occurred in the two PCMHs. Each PCMH consisted of a Traditional Clinic that saw patients on a scheduled basis and a Convenient Care Clinic that accepted walk-in visits. Comparisons between NPs and physicians were conducted according to PCMH site and clinic type for the following variables: 1) number of patient visits per provider Full Time Equivalent (FTE); 2) patient age and gender; 3) level of patient health as measured by the Charlson Index; and 4) prevalent International Classification of Diseases, Revision 9 (ICD-9) diagnostic codes assigned to patients.

Generally, NPs saw fewer patients per FTE than physicians at the Traditional Clinics but more at Convenient Care. NPs also treated more female and younger patients across PCMHs. The Charlson Index showed patients in both PCMHs to be predominantly healthy, but NPs tended to treat less complex problems than physicians. NPs’ ICD-9 diagnostic codes more frequently concerned minor, acute illnesses or well person examinations compared to physicians, who assigned codes indicative of chronic conditions.

The differences between NPs and physicians appear to be linked to PCMH policies that preferentially schedule and assign older, male, and chronically ill patients to physicians. In conclusion, NPs are underutilized regarding the range of patients and health conditions they could appropriately address in these settings. Suggestions for more strategic and efficient distribution of NP services were offered.


Date: October 23, 2012

Time: 9:00 AM to 11:00 AM

Place: College of Nursing Administration Building, Conference Room 2


Defense of Final Project Committee


Richard Yakimo, PhD(Advisor)

Susan Farberman, DNP


Susan Kendig, MSN, JD

Thomas Hale, MD, PhD