Differentiated primary care and evidence-based practice: the Columbia nursing experiment.

Changes in our health care system and the growth of managed care have turned the spotlight on primary care and are driving sweeping reforms in health professions education, patient care, and research. The Columbia University School of Nursing has responded to this challenge by establishing a community primary care clinic managed by nurse practitioners. This article describes this clinic, an evaluation study of this practice, and their relevance to pending policy discussions on primary care provider designation and payment and the regulation of scope of professional practice.