May Nawal Lutfiyya1, Lisa Tomai2, Bianca Frogner3, Frank Cerra1, Daniel Zismer4, Stephen Parente5. 1. National Center for Interprofessional Practice and Education, Academic Health Center, University of Minnesota, Minneapolis, Minnesota, USA. 2. Consultant to the National Center for Interprofessional Practice and Education, Academic Health Center, University of Minnesota, Minneapolis, Minnesota, USA. 3. Department of Family Medicine, University of Washington, Seattle, Washington, USA. 4. School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA. 5. Carlson School of Management, University of Minnesota, Minneapolis, Minnesota, USA.
Abstract
AIMS: The aim of this study was to answer the overall question: Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)? BACKGROUND: In the USA as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary health care is one area where healthcare reform has received considerable attention, in part because of continued projections of primary care physician shortages. Many argue that nurse practitioners are one solution to ease the consequences of the projected shortage of primary care physicians in the USA as well as other developed countries. DESIGN: Cross-sectional quantitative analysis of 2012 Medicare claims data. METHODS: A 5% Standard Analytic File of 2012 Medicare claims data for beneficiaries with Type 2 diabetes were analysed. A medical productivity index was used to stratify patients as healthiest and least healthy who were seen by either nurse practitioners only or primary care physicians exclusively. Included in the analyses were health services utilization, health outcomes and healthcare cost variables. RESULTS: The patients in the nurse practitioner only group, overall and stratified by medical productivity index status, had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare services utilization, patient health outcomes and healthcare costs. CONCLUSIONS: These findings inform current healthcare workforce conversations regarding healthcare quality, outcomes and costs. Our results suggest nurse practitioner engagement in chronic care patient management in primary care settings is associated with lower cost and better quality health care.
AIMS: The aim of this study was to answer the overall question: Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)? BACKGROUND: In the USA as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary health care is one area where healthcare reform has received considerable attention, in part because of continued projections of primary care physician shortages. Many argue that nurse practitioners are one solution to ease the consequences of the projected shortage of primary care physicians in the USA as well as other developed countries. DESIGN: Cross-sectional quantitative analysis of 2012 Medicare claims data. METHODS: A 5% Standard Analytic File of 2012 Medicare claims data for beneficiaries with Type 2 diabetes were analysed. A medical productivity index was used to stratify patients as healthiest and least healthy who were seen by either nurse practitioners only or primary care physicians exclusively. Included in the analyses were health services utilization, health outcomes and healthcare cost variables. RESULTS: The patients in the nurse practitioner only group, overall and stratified by medical productivity index status, had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare services utilization, patient health outcomes and healthcare costs. CONCLUSIONS: These findings inform current healthcare workforce conversations regarding healthcare quality, outcomes and costs. Our results suggest nurse practitioner engagement in chronic care patient management in primary care settings is associated with lower cost and better quality health care.