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Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus.

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.
PMID
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Authors

Mayor MeshTerms

Nurse Practitioners

Personnel Staffing and Scheduling

Physician Assistants

Physicians, Primary Care

Primary Health Care

Veterans

Keywords

Veterans Administration

health workforce

nurse practitioner

physician assistant

primary care

Journal Title inquiry : a journal of medical care organization, provision and financing
Publication Year Start




PMID- 28617196
OWN - NLM
STAT- MEDLINE
DA  - 20170615
DCOM- 20170711
LR  - 20170713
IS  - 1945-7243 (Electronic)
IS  - 0046-9580 (Linking)
VI  - 54
DP  - 2017 Jan 01
TI  - Factors Associated With Having a Physician, Nurse Practitioner, or Physician
      Assistant as Primary Care Provider for Veterans With Diabetes Mellitus.
PG  - 46958017712762
LID - 10.1177/0046958017712762 [doi]
AB  - 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 &gt;2.0 compared with the group having DCG &lt;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.
FAU - Morgan, Perri
AU  - Morgan P
AD  - 1 Duke University, Durham, NC, USA.
FAU - Everett, Christine M
AU  - Everett CM
AD  - 1 Duke University, Durham, NC, USA.
FAU - Smith, Valerie A
AU  - Smith VA
AD  - 1 Duke University, Durham, NC, USA.
AD  - 2 Durham Veterans Affairs Medical Center, Durham, NC, USA.
FAU - Woolson, Sandra
AU  - Woolson S
AD  - 2 Durham Veterans Affairs Medical Center, Durham, NC, USA.
FAU - Edelman, David
AU  - Edelman D
AD  - 1 Duke University, Durham, NC, USA.
AD  - 2 Durham Veterans Affairs Medical Center, Durham, NC, USA.
FAU - Hendrix, Cristina C
AU  - Hendrix CC
AD  - 1 Duke University, Durham, NC, USA.
AD  - 2 Durham Veterans Affairs Medical Center, Durham, NC, USA.
FAU - Berkowitz, Theodore S Z
AU  - Berkowitz TSZ
AD  - 2 Durham Veterans Affairs Medical Center, Durham, NC, USA.
FAU - White, Brandolyn
AU  - White B
AD  - 2 Durham Veterans Affairs Medical Center, Durham, NC, USA.
FAU - Jackson, George L
AU  - Jackson GL
AD  - 1 Duke University, Durham, NC, USA.
AD  - 2 Durham Veterans Affairs Medical Center, Durham, NC, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Inquiry
JT  - Inquiry : a journal of medical care organization, provision and financing
JID - 0171671
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Diabetes Mellitus/*therapy
MH  - Electronic Health Records
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Nurse Practitioners
MH  - *Personnel Staffing and Scheduling
MH  - *Physician Assistants
MH  - *Physicians, Primary Care
MH  - *Primary Health Care
MH  - Retrospective Studies
MH  - *Veterans
OTO - NOTNLM
OT  - Veterans Administration
OT  - health workforce
OT  - nurse practitioner
OT  - physician assistant
OT  - primary care
EDAT- 2017/06/16 06:00
MHDA- 2017/07/14 06:00
CRDT- 2017/06/16 06:00
AID - 10.1177/0046958017712762 [doi]
PST - ppublish
SO  - Inquiry. 2017 Jan 1;54:46958017712762. doi: 10.1177/0046958017712762.