Utilization and Costs by Primary Care Provider Type Are There Differences Among Diabetic Patients of Physicians, Nurse Practitioners, and Physician Assistants?
Utilization and Costs by Primary Care Provider Type Are There Differences Among Diabetic Patients of Physicians, Nurse Practitioners, and Physician Assistants?
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DOI：
10.1097/mlr.0000000000001326
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发表时间：
2020-08-01
期刊：
影响因子：
3
通讯作者：
Jackson, George L.
中科院分区：
文献类型：
--
作者：
Smith, Valerie A.;Morgan, Perri A.;Jackson, George L.
目的：本研究的目的是比较糖尿病患者与医生，执业护士（NP），或医生助理（PA）初级保健提供者（PCPs）之间的医疗保健利用率和成本。研究设计和方法：队列研究使用退伍军人事务部（VA）电子健康记录数据，检查PCP类型和利用率之间的关系，并在1年以上的368,481名成年糖尿病患者的成本。2013年，对PCP类型与利用率和成本之间的关系进行了检查，并对患者和设施特征进行了广泛调整。急诊科和门诊分析使用负二项模型;住院使用logistic回归。结果：74.9%（n= 276，009）、18.2%（n = 67，120）和6.9%（n= 25，352）的患者中，PCP为医生、NP和PA。NP和PA患者的住院率较低[NP与医生的比值比为0.90，95%置信区间（CI）=0.87-0.93; PA与医生的比值比为0.92，95% CI=0.87-0.97]，急诊使用率较低（医生平均就诊0.67次，95% CI=0.65-0.68; NP平均就诊0.60次，95% CI=0.58-0.63; PA平均就诊0.59次，95% CI=0.56-0.63）。这意味着NP和PA每年每位患者的医疗保健费用减少了500 - 700美元（P
Objective: The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs).Research Design and Methods: Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics. Emergency department and outpatient analyses used negative binomial models; hospitalizations used logistic regression. Costs were analyzed using generalized linear models.Results: PCPs were physicians, NPs, and PAs for 74.9% (n=276,009), 18.2% (n=67,120), and 6.9% (n=25,352) of patients respectively. Patients of NPs and PAs have lower odds of inpatient admission [odds ratio for NP vs. physician 0.90, 95% confidence interval (CI)=0.87-0.93; PA vs. physician 0.92, 95% CI=0.87-0.97], and lower emergency department use (0.67 visits on average for physicians, 95% CI=0.65-0.68; 0.60 for NPs, 95% CI=0.58-0.63; 0.59 for PAs, 95% CI=0.56-0.63). This translates into NPs and PAs having similar to$500-$700 less health care costs per patient per year (P