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

Publication ,  Journal Article
Morgan, P; Everett, CM; Smith, VA; Woolson, S; Edelman, D; Hendrix, CC; Berkowitz, TSZ; White, B; Jackson, GL
Published in: Inquiry
January 1, 2017

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.

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Published In

Inquiry

DOI

EISSN

1945-7243

Publication Date

January 1, 2017

Volume

54

Start / End Page

46958017712762

Location

United States

Related Subject Headings

  • Veterans
  • Retrospective Studies
  • Primary Health Care
  • Physicians, Primary Care
  • Physician Assistants
  • Personnel Staffing and Scheduling
  • Nurse Practitioners
  • Middle Aged
  • Male
  • Humans
 

Citation

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Chicago
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Morgan, P., Everett, C. M., Smith, V. A., Woolson, S., Edelman, D., Hendrix, C. C., … Jackson, G. L. (2017). Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus. Inquiry, 54, 46958017712762. https://doi.org/10.1177/0046958017712762
Morgan, Perri, Christine M. Everett, Valerie A. Smith, Sandra Woolson, David Edelman, Cristina C. Hendrix, Theodore S. Z. Berkowitz, Brandolyn White, and George L. Jackson. “Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus.Inquiry 54 (January 1, 2017): 46958017712762. https://doi.org/10.1177/0046958017712762.
Morgan P, Everett CM, Smith VA, Woolson S, Edelman D, Hendrix CC, et al. Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus. Inquiry. 2017 Jan 1;54:46958017712762.
Morgan, Perri, et al. “Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus.Inquiry, vol. 54, Jan. 2017, p. 46958017712762. Pubmed, doi:10.1177/0046958017712762.
Morgan P, Everett CM, Smith VA, Woolson S, Edelman D, Hendrix CC, Berkowitz TSZ, White B, Jackson GL. Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus. Inquiry. 2017 Jan 1;54:46958017712762.

Published In

Inquiry

DOI

EISSN

1945-7243

Publication Date

January 1, 2017

Volume

54

Start / End Page

46958017712762

Location

United States

Related Subject Headings

  • Veterans
  • Retrospective Studies
  • Primary Health Care
  • Physicians, Primary Care
  • Physician Assistants
  • Personnel Staffing and Scheduling
  • Nurse Practitioners
  • Middle Aged
  • Male
  • Humans