As the number of patients living with multiple chronic conditions continues to rise, healthcare systems are increasingly relying on nurse practitioners (NPs) to help manage complex care in primary care settings. In many regions facing physician shortages, NPs now provide a substantial share of frontline care — including for patients with cardiometabolic disease, polypharmacy, and other high-acuity needs.

Recent research has begun examining whether NP-led or NP-integrated care models influence outcomes such as hospitalizations, emergency department visits, and overall healthcare utilization among patients with multiple chronic conditions. With multimorbidity becoming increasingly common in aging populations, many health systems are exploring whether team-based care models that incorporate NPs can help improve continuity of care and reduce hospitalizations.

Evidence on Hospitalizations and Healthcare Utilization

A June 26, 2024, study published in Nursing Research examined hospitalization and emergency department use among Medicare beneficiaries with multiple chronic conditions treated in practices that employ NPs. The analysis of nearly 400,000 patients found no increase in hospitalization or emergency department utilization in practices with NP involvement, suggesting that NP-integrated primary care models can manage complex patient populations without worsening acute care use.

Policy factors may also influence how effectively NPs can manage medically complex patients. A September 2025 study published in the Journal of Health Economics found that states granting full practice authority to NPs experienced reductions in avoidable hospitalizations for chronic conditions, including diabetes and other ambulatory care — sensitive conditions.

More recent evidence has reinforced these findings. A systematic review published on January 27, 2026, in The European Journal of General Practice examining the role of NPs in chronic disease management in primary care found that NP involvement improved access to care and patient satisfaction, while clinical outcomes were generally comparable to those achieved in physician-led models, particularly when NPs worked collaboratively within team-based care structures.

Earlier evidence focused specifically on patients with multimorbidity has reached similar conclusions. A systematic review published online on July 12, 2023, in Medical Care Research and Review found that primary care models incorporating NPs were associated with similar or lower rates of hospitalizations and emergency department visits, with no evidence of worse outcomes compared with models without NP involvement.

Taken together, this research suggests that NPs can play an important role in managing patients with multimorbidity, particularly when they are integrated into care teams that emphasize continuity, proactive monitoring, and coordination across specialties.

Continuity and Early Intervention

Alison Christel, MSN, FNP-C, who serves patients through her company PlantedRx, an online whole food nutrition consultancy, said continuity is often one of the most important mechanisms through which NPs can help reduce hospitalizations among medically complex patients.

“Studies consistently show that NP-led primary care achieves comparable, and in some cases better, hospitalization outcomes for complex patients compared to physician-only models,” Christel said. “A key driver is continuity: NPs tend to spend more time with patients, which means medication reconciliation, early symptom recognition, and care coordination gaps get caught before they become admissions.”

For patients managing several chronic conditions simultaneously, those early interventions can be critical. NPs frequently monitor lab trends, medication changes, and patient-reported symptoms between visits, helping clinicians detect problems before they escalate.

Jamilla Campo, MSN, PMHNP-BC, a psychiatric mental health NP working across skilled nursing facilities, behavioral stabilization programs, and intellectual and developmental disability settings in New York, New Jersey, and Pennsylvania, said early recognition of subtle changes in patient status is a key part of NP practice in long-term care and community settings.

“Nurse practitioners often have frequent contact with patients and staff, which allows us to recognize subtle changes in clinical status earlier,” Campo said.

Behavioral symptoms or agitation, she said, may sometimes be interpreted as psychiatric concerns when they are actually signs of underlying medical problems.

“I have encountered cases where agitation or vocal distress was ultimately related to untreated pain, infection, or hypoxia due to an empty oxygen tank,” she said. “Identifying those problems early can help prevent deterioration that might otherwise lead to hospitalization.”

NPs as a Central Touchpoint for Complex Patients

For patients with cardiometabolic disease, polypharmacy, and high care needs, Christel said, NPs frequently function as the most consistent clinical touchpoint.

“For someone managing type 2 diabetes, hypertension, and heart failure on eight medications, the NP is frequently the one reviewing labs between visits, fielding patient messages, and flagging early decompensation,” she said.

Patients with multimorbidity who also have cognitive impairment or communication limitations may benefit particularly from NP-integrated care models, Campo said. In settings where dementia care or intellectual and developmental disability are involved, medical problems may first present as behavioral changes rather than clearly reported symptoms.

“In those situations, a holistic assessment that considers environmental, medical, and psychosocial factors can be critical to identifying the underlying cause of distress,” Campo said.

The Kidney Disease Example

For patients with kidney disease, the complexity of care often extends well beyond nephrology itself. Many patients simultaneously manage diabetes, hypertension, cardiovascular disease, and multiple medications, making coordinated care essential.

Bridget McCoy, MSN, CRNP, director of clinical operations for integrated kidney care at Denver-based DaVita Kidney Care, said NPs frequently serve as key coordinators within these highly complex care environments.

“Value-based kidney care models have proven to reduce preventable hospitalizations and deliver better health outcomes,” McCoy said.

Because patients with kidney failure often manage multiple chronic conditions and complex medication regimens, she said, NPs play a critical role in helping coordinate care and support quality of life.

Policy and Practice Barriers

Despite the expanding role of NPs in complex care, operational and policy environments can significantly influence how effectively NPs can practice.

“Nurse practitioners are highly skilled clinicians, and they are most effective when operational and policy environments are designed to support their full scope of practice,” McCoy said.

System-level challenges can also affect outcomes for medically complex patients, Campo noted. Transitions between hospital and postacute care may involve incomplete documentation, medication discrepancies, or delays in specialty consultations.

In those situations, NPs often help identify clinical concerns quickly and advocate for appropriate levels of care.

Misconceptions About NP Roles

Misconceptions about the role NPs play in complex care remain common.

“A common misconception is that NPs function mainly as assessors or documentation support,” McCoy said.

Campo added that care for patients with multimorbidity typically operates as a collaborative, team-based model.

“One common misconception is that nurse practitioners are managing complex patients independently of physicians,” she said. “In reality, care for patients with multimorbidity typically functions as a collaborative model that includes physicians, nurses, pharmacists, therapists, and social workers.”

Within those teams, NPs often contribute through day-to-day monitoring, communication across providers, and early recognition of changes in patient status — efforts that can help prevent avoidable hospitalizations and improve outcomes for medically complex patients.

No reported disclosures.