JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 67 CLINICAL PRACTICE A Unique Set of Interactions: The MSU Sustained Partnership Model of Nurse Practitioner Primary Care Katherine Dontje, MSN, APRN, BC, FNP, Assistant Professor William Corser, PhD, RN, CNAA, Assistant Professor Grace Kreulen, PhD, RN, Assistant Professor Anne Teitelman, PhD, APRN, BC, Assistant Professor INTRODUCTION Nurse practitioners (NPs) have provided primary health care services in community settings since 1965, frequently caring for clients who have been underserved or uninsured (Anderko & Kinion, 2001; Institute of Medicine, 2000). Still, the nursing literature provides very little in the way of a concep- tual framework describing the fundamental processes of care that occur as NPs interact with their clients. The development of a meaningful framework to help define the differences between NP practices and other models of care, such as the care physicians deliver, is important for both NP students and clinicians. Nursing faculties have taught students that the relationships between NPs and their clients are inherently different from those between other profes- sionals and clients. The patterns of practice and outcomes of care among NP clinicians in primary care settings, however, have not been clearly identified and/or tested (Anderko & Uscian, 2000; Kerekes, Jenkins, & Torrisi, 1996; Lundeen, 1997; Summers, 2002). This paucity of meaningful frameworks with which to prepare students or educate clients about NPs in primary care settings may become increasingly costly for NPs who need to be able to artic- ulate the benefits and differences of their model of care to clients and stu- dents. As Norma Lang (Clark & Lang, 1992) observed years ago, “If you can’t describe it [a nursing practice], you can’t teach it, study it, get reimbursed for it, or put it into public policy” (p. 109). Researchers who have attempted to validate the nature of NP primary care practices have usually compared the outcomes of NP models of care to out- comes of care delivered by physicians or physician assistants, rather than exam- ining discipline-specific care processes. One of the largest studies of the out- comes of NP practices was conducted by Mundinger and colleagues (2000), who conducted a randomized trial demonstrating that the quality of primary care provided by NPs was equal to the quality of that provided by physicians. However, we wish to suggest that research concerning NP primary care services needs to be based on a conceptual model delineating the integral processes of NP care delivery that can be correlated with specific client outcomes. The main purposes of this article are (a) to review the nursing literature that describes the important concepts thought to underlie the overall form of NP primary care and (b) to present a unified conceptual model of this type of practice. We will also propose a set of outcomes for future research designed to test this framework in primary care settings. Purpose To present a unified conceptual model that identifies the integral processes of nurse practi- tioner (NP) care delivery and that integrates major structural influences and potential out- comes. The model is further characterized to delineate the unique and “value-added” nature of NP primary care and to describe how this nature may be correlated with specific clinical outcomes. Data Sources Extensive review of the literature, relevant con- ceptual models, clinical experiences of the authors, and two sets of qualitative data exploring differences between NP practice and other practices. Conclusions The basis of NP primary care is the unique provider-client relationship that develops within the primary care setting. This relation- ship is oriented toward (a) helping clients become empowered to more appropriately manage their own care in a way that will best meet their needs, (b) encouraging mutual deci- sion making, (c) ensuring clients’ continuity of care, and (d) providing a holistic approach to primary care. The major structural influences are NP role components, interdisciplinary practice relationships, budget resources and payer mix, and environmental characteristics. The potential outcomes are increased health- promoting behaviors, improved utilization of care, higher client satisfaction levels, and improved health status.