Comparative Effectiveness of Outpatient Cardiovascular Disease and Diabetes Care Delivery between Advanced Practice Providers and Physician Providers in Primary Care: Implications for Care under the Affordable Care Act

• Published in: The American heart journal 2016-11, Vol.181, p.74-82
• Main Authors: Virani, Salim S., MD, PhD, Akeroyd, Julia M., MPH, Ramsey, David J., PhD, Chan, Winston J., MPH, Frazier, Lorraine, PhD, RN, Nasir, Khurram, MD, Rajan, Suja, PhD, MS, Ballantyne, Christie M., MD, Petersen, Laura A., MD, MPH
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Ambulatory Care - methods; Blood Glucose - metabolism; Blood Pressure; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - metabolism; Cardiovascular Diseases - therapy; Cholesterol, LDL - metabolism; Chronic illnesses; Codes; Delivery of Health Care - methods; Diabetes; Diabetes Mellitus - metabolism; Diabetes Mellitus - therapy; Female; Fiscal years; Glycated Hemoglobin A - metabolism; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertension; Male; Metastasis; Middle Aged; Nurse Practitioners; Patient Protection & Affordable Care Act 2010-US; Patient Protection and Affordable Care Act; Patients; Physician Assistants; Physicians; Physicians, Primary Care; Primary care; Primary Health Care - standards; Quality; Quality of Health Care; Studies; Uninsured people; United States; United States Department of Veterans Affairs
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2016.07.020

Abstract Objective To compare quality of diabetes and cardiovascular disease (CVD) care between advanced practice providers (APPs) and physicians in a primary care setting. Research Design and Methods We identified diabetes (n = 1,022,588) and CVD (n = 1,187,035) patients receiving primary care between October 2013 and September 2014 in 130 Veterans Affairs facilities. We compared glycemic control (HbA1c< 7%) in diabetic patients, BP< 140/90 mmHg in diabetic or CVD patients, cholesterol control (LDL-C < 100 mg/dL, receiving a statin) in diabetic or CVD patients, and those receiving a beta-blocker (with history of myocardial infarction in the last 2 years) among patients receiving care from physicians and APPs. We also compared the proportion meeting composite measure (glycemic, BP, and cholesterol control in diabetic patients; BP, cholesterol control, and receipt of beta-blocker among eligible CVD patients). Results Diabetic patients receiving care from APPs were statistically more likely to have glycemic (50 vs. 51.4%, OR 1.06 [1.05–1.08]), BP control (77.5 vs.78.4%, OR 1.04 [1.03–1.06]) whereas, patients receiving care from physicians were more likely to have cholesterol control (receipt of statin 68 vs. 66.5%, OR 0.94 [0.93–0.95]) in adjusted models although, these differences are not clinically significant. Similar results were seen in CVD patients. Few patients met the composite measure (27.1% and 27.6% of diabetic and 54.0% and 54.8% of CVD patients receiving care from physicians and APPs, respectively). Conclusions Diabetes and CVD care quality was comparable between physicians and APPs with clinically insignificant differences. Regardless of provider type, there is a need to improve performance on eligible measures in diabetes or CVD patients.