Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study.
Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study.
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DOI：
10.1136/bmjoq-2022-002229
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发表时间：
2023-06
期刊：
影响因子：
1.4
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中科院分区：
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跨专业初级保健（PC）团队是提供高质量护理的关键。PC提供者经常“共享”患者（例如，患者可能在同一诊所看到多个提供者），导致提供者之间的访问相互依赖。然而，人们仍然担心PC提供商的相互依赖会降低护理质量，导致一些组织在创建多个提供商团队时犹豫不决。如果PC提供者团队正式化，则应针对不同医疗复杂程度的患者确定PC常规护理提供者（UPC）类型（医生、执业护士（NP）或医生助理/助理（PA））。评估PC提供者相互依赖性、UPC类型和患者复杂性对成人糖尿病患者糖尿病特异性结局的影响。使用来自美国北卡罗来纳州中部26个PC实践的电子健康记录数据的队列研究。2016年和2017年接受PC治疗的成人糖尿病患者（N=10 498）。2017年糖尿病控制测试，血脂水平测试，平均糖化血红蛋白（HbA 1c）值和平均低密度脂蛋白（LDL）值。接受指南推荐检测的比例较高（HbA 1c为72%，LDL检测为66%），HbA 1c值为7.5%，LDL值为88.5 mg/dL。当控制一系列患者和面板水平变量时，PC提供者相互依赖性的增加与糖尿病特异性结局无显著相关性。同样，与医生相比，NP/PA UPC患者的糖尿病结局无显著差异。患者慢性病的数量和类型确实会影响接受检测，但不会影响HbA 1c和LDL的平均值。PC上的一系列UPC类型多个提供者团队可以提供指南推荐的糖尿病护理。然而，患者的慢性疾病的数量和类型单独影响测试的接收，但不是HbA 1c和LDL的平均值。
Interprofessional primary care (PC) teams are key to the provision of high-quality care. PC providers often ‘share’ patients (eg, a patient may see multiple providers in the same clinic), resulting in between-visit interdependence between providers. However, concern remains that PC provider interdependence will reduce quality of care, causing some organisations to hesitate in creating multiple provider teams. If PC provider teams are formalised, the PC usual provider of care (UPC) type (physician, nurse practitioner (NP) or physician assistant/associate (PA)) should be determined for patients with varying levels of medical complexity. To evaluate the impact of PC provider interdependence, UPC type and patient complexity on diabetes-specific outcomes for adult patients with diabetes. Cohort study using electronic health record data from 26 PC practices in central North Carolina, USA. Adult patients with diabetes (N=10 498) who received PC in 2016 and 2017. Testing for diabetes control, testing for lipid levels, mean glycated haemoglobin (HbA1c) values and mean low-density lipoprotein (LDL) values in 2017. Receipt of guideline recommended testing was high (72% for HbA1c and 66% for LDL testing), HbA1c values were 7.5% and LDL values were 88.5 mg/dL. When controlling for a range of patient and panel level variables, increases in PC provider interdependence were not significantly associated with diabetes-specific outcomes. Similarly, there were no significant differences in the diabetes outcomes for patients with NP/PA UPCs when compared with physicians. The number and type of a patient’s chronic conditions did impact the receipt of testing, but not average values for HbA1c and LDL. A range of UPC types on PC multiple provider teams can deliver guideline-recommended diabetes care. However, the number and type of a patient’s chronic conditions alone impacted the receipt of testing, but not average values for HbA1c and LDL.