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Comparative Study
. 2020 Apr;55(2):178-189.
doi: 10.1111/1475-6773.13246. Epub 2020 Jan 13.

Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care

Chuan-Fen Liu  1 , Paul L Hebert  1   2 , Jamie H Douglas  2 , Emily L Neely  2 , Christine A Sulc  2 , Ashok Reddy  2   3 , Anne E Sales  4   5 , Edwin S Wong  1   2
Affiliations
Comparative Study

Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care

Chuan-Fen Liu et al. Health Serv Res. 2020 Apr.

Abstract

Objective: To examine whether nurse practitioner (NP)-assigned patients exhibited differences in utilization, costs, and clinical outcomes compared to medical doctor (MD)-assigned patients.

Data sources: Veterans Affairs (VA) administrative data capturing characteristics, outcomes, and provider assignments of 806 434 VA patients assigned to an MD primary care provider (PCP) who left VA practice between 2010 and 2012.

Study design: We applied a difference-in-difference approach comparing outcomes between patients reassigned to MD and NP PCPs, respectively. We examined measures of outpatient (primary care, specialty care, and mental health) and inpatient (total and ambulatory care sensitive hospitalizations) utilization, costs (outpatient, inpatient and total), and clinical outcomes (control of hemoglobin A1c, LDL, and blood pressure) in the year following reassignment.

Principal findings: Compared to MD-assigned patients, NP-assigned patients were less likely to use primary care and specialty care services and incurred fewer total and ambulatory care sensitive hospitalizations. Differences in costs, clinical outcomes, and receipt of diagnostic tests between groups were not statistically significant.

Conclusions: Patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients. NPs may offer a cost-effective approach to addressing anticipated shortages of primary care physicians.

Keywords: cost; health workforce; nurse practitioner; primary care; quality of care; utilization.

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Conflict of interest statement

All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Algorithm for defining sample of VA primary care patients reassigned to NPs and MDs, respectively
Figure 2
Figure 2
Differences in utilization between NP and MD patients by level of comorbidity [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. Agency for Healthcare Research and Quality .The number of nurse practitioners and physician assistants practicing primary care in The United States. 2011. http://www.ahrq.gov/research/findings/factsheets/primary/pcwork2/index.html. Accessed June 1, 2019.
    1. Fletcher CE, Copeland LA, Lowery JC, Reeves PJ. Nurse practitioners as primary care providers within the VA. Mil Med. 2011;176(7):791‐797. - PubMed
    1. U.S. Department of Veterans Affairs . VA Benefits & Health Care Utilization. 2018. https://www.va.gov/vetdata/docs/pocketcards/fy2019q1.pdf. Accessed June 1, 2019.
    1. Hobson A, Curtis A. Improving the care of veterans: the role of nurse practitioners in team‐based population health management. J Am Assoc Nurse Pract. 2017;29(11):644‐650. - PubMed
    1. Morgan P, Abbott D, McNeil R, Fisher D. Characteristics of primary care office visits to nurse practitioners, physicians assistants and physicians in the United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross‐sectional analysis. Hum Resour Health. 2012;10:42. - PMC - PubMed

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