Faculty Collaboration Database

Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus. Inquiry 2017 Jan 01;54:46958017712762

Date

06/16/2017

Pubmed ID

28617196

Pubmed Central ID

PMC5558456

DOI

10.1177/0046958017712762

Scopus ID

2-s2.0-85023631213 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines whether medical and social complexity of patients is associated with whether their primary care provider (PCP) type is a physician, NP, or PA. In this national retrospective cohort study, we use 2012-2013 national Veterans Administration (VA) electronic health record data from 374 223 veterans to examine whether PCP type is associated with patient, clinic, and state-level factors representing medical and social complexity, adjusting for all variables simultaneously using a generalized logit model. Results indicate that patients with physician PCPs are modestly more medically complex than those with NP or PA PCPs. For the group having a Diagnostic Cost Group (DCG) score >2.0 compared with the group having DCG <0.5, odds of having an NP or a PA were lower than for having a physician PCP (NP odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.79-0.88; PA OR = 0.85, CI: 0.80-0.89). Social complexity is not consistently associated with PCP type. Overall, we found minor differences in provider type assignment. This study improves on previous work by using a large national dataset that accurately ascribes the work of NPs and PAs, analyzing at the patient level, analyzing NPs and PAs separately, and addressing social as well as medical complexity. This is a requisite step toward studies that compare patient outcomes by provider type.

Author List

Morgan P, Everett CM, Smith VA, Woolson S, Edelman D, Hendrix CC, Berkowitz TSZ, White B, 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
Diabetes Mellitus
Electronic Health Records
Female
Humans
Male
Middle Aged
Nurse Practitioners
Personnel Staffing and Scheduling
Physician Assistants
Physicians, Primary Care
Primary Health Care
Retrospective Studies
Veterans