Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians.
Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians.
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DOI：
10.1097/mlr.0000000000000406
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发表时间：
2015-09
期刊：
影响因子：
3
通讯作者：
Goodwin JS
中科院分区：
文献类型：
--
作者：
Kuo YF;Chen NW;Baillargeon J;Raji MA;Goodwin JS
很少有比较存在的初级保健提供的执业护士（NP）与医生的质量。2007-2010年诊断为糖尿病的患者（n= 345，819）在给定的一年内接受了NP或全科医生的所有初级护理，这些患者选自全国医疗保险受益人样本。我们比较了接受NP与全科医生初级保健的患者中潜在可预防的住院率。各种统计方法，包括多变量分析，逆概率加权的倾向评分，非汇总倾向评分调整和匹配，以及工具变量（IV）分析，用于控制两组之间的患者特征的差异。从NP或医生那里接受所有初级保健的患者因年龄、性别、种族/民族、社会经济地位、居住地区和前一年提供者就诊次数而异。非合并倾向匹配大幅降低了差异，但两种IV方法均未令人满意地降低差异。在多变量分析中，接受NP的初级护理与潜在可预防疾病住院风险降低相关（OR：0.90，95%CI=0.87-0.93）。使用条件Logistic回归模型和倾向方法也发现了类似的结果。我们发现，在我们的分析中，“其他住院治疗”的减少较小（OR：0.96，95%CI=0.95-0.98）。两项IV分析均显示NP治疗与潜在可预防的住院率较低之间存在相关性，但只有一项结果具有统计学意义。使用潜在的可预防的住院作为质量指标，由NP提供的初级保健至少与全科医生提供的初级保健相当。
Few comparisons exist of the quality of primary care provided by nurse practitioners (NPs) versus physicians. Patients with a diagnosis of diabetes in 2007–2010 (n=345,819) who received all primary care from NPs or from generalist physicians in a given year were selected from a national sample of Medicare beneficiaries. We compared the rate of potentially preventable hospitalizations among patients who received primary care from NPs versus generalist physicians. Various statistical methods—including multivariable analysis, inverse probability weighting of propensity score, non-pooling propensity score adjustment and matching, and instrumental variable (IV) analysis— were used to control for differences in patient characteristics between the two groups. Patients who received all of their primary care from NPs or from physicians differed by age, gender, race/ethnicity, socioeconomic status, residential area and number of provider visits in the previous year. Non-pooling propensity matching substantially reduced the differences, but neither IV approach satisfactorily reduced the differences. In multivariable analyses, receipt of primary care from an NP was associated with a decreased risk of hospitalization for potentially preventable conditions (OR: 0.90, 95%CI=0.87–0.93). Similar results were found using conditional logistic regression models with propensity methods. We found smaller reductions in our analyses of “other hospitalizations” (OR: 0.96, 95%CI=0.95–0.98). Both IV analyses showed associations between NP care and lower potentially preventable hospitalizations, but only one result was statistically significant. Using potentially preventable hospitalizations as a quality indicator, primary care provided by NPs was at least comparable to that provided by generalist physicians.