Faculty Collaboration Database

Utilization and Costs by Primary Care Provider Type: Are There Differences Among Diabetic Patients of Physicians, Nurse Practitioners, and Physician Assistants? Med Care 2020 Aug;58(8):681-688

Date

04/09/2020

Pubmed ID

32265355

Pubmed Central ID

PMC7375947

DOI

10.1097/MLR.0000000000001326

Scopus ID

2-s2.0-85083593057 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

OBJECTIVE: The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs).

RESEARCH DESIGN AND METHODS: Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics. Emergency department and outpatient analyses used negative binomial models; hospitalizations used logistic regression. Costs were analyzed using generalized linear models.

RESULTS: PCPs were physicians, NPs, and PAs for 74.9% (n=276,009), 18.2% (n=67,120), and 6.9% (n=25,352) of patients respectively. Patients of NPs and PAs have lower odds of inpatient admission [odds ratio for NP vs. physician 0.90, 95% confidence interval (CI)=0.87-0.93; PA vs. physician 0.92, 95% CI=0.87-0.97], and lower emergency department use (0.67 visits on average for physicians, 95% CI=0.65-0.68; 0.60 for NPs, 95% CI=0.58-0.63; 0.59 for PAs, 95% CI=0.56-0.63). This translates into NPs and PAs having ~$500-$700 less health care costs per patient per year (P<0.0001).

CONCLUSIONS: Expanded use of NPs and PAs in the PCP role for some patients may be associated with notable cost savings. In our cohort, substituting care patterns and creating similar clinical situations in which they practice, NPs and PAs may have reduced costs of care by up to 150-190 million dollars in 2013.

Author List

Smith VA, Morgan PA, Edelman D, Woolson SL, Berkowitz TSZ, Van Houtven CH, Hendrix CC, Everett CM, White BS, Jackson GL

Author

Christine M. Everett PhD, PAC Chief, Director, Professor in the Health Sciences Education department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Cohort Studies
Diabetes Mellitus
Female
Health Personnel
Humans
Male
Middle Aged
Nurse Practitioners
Patient Acceptance of Health Care
Physician Assistants
Physicians
Primary Health Care
United States
United States Department of Veterans Affairs