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

Authors

Salim S. Virani, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, United StatesFollow
Julia M. Akeroyd, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, United States
David J. Ramsey, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, United States
Winston J. Chan, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, United States
Lorraine Frazier, The University of Texas Health Science Center at Houston (UTHealth) School of Nursing, United States
Khurram Nasir, Center for Healthcare Advancement & Outcomes at Baptist Health South Florida, United States
Suja S. Rajan, University of Texas - Health Science Center at Houston, United States
Christie M. Ballantyne, aylor College of Medicine, United States
Laura A. Petersen, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, United States

Document Type

Article

Department

Cardiology

Abstract

Background: The objective was to compare quality of diabetes and cardiovascular disease (CVD) care between advanced practice providers (APPs) and physicians in a primary care setting.
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 (hemoglobin A1c <7%) in diabetic patients, blood pressure (BP) <140/90 mmHg in diabetic or CVD patients, cholesterol control (low-density lipoprotein cholesterol<100 mg/dL, receiving a statin) in diabetic or CVD patients, and those receiving a β-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 β-blocker among eligible CVD patients).
Results: Diabetic patients receiving care from APPs were statistically more likely to have glycemic (50% vs 51.4%, odds ratio [OR] 1.06 [1.05-1.08]) and 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.

Comments

Issue no.is not provided by the author/publisher. This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

American Heart Journal

Recommended Citation

Virani, S. S., Akeroyd, J. M., Ramsey, D. J., Chan, W. J., Frazier, L., Nasir, K., Rajan, S. S., Ballantyne, C. M., Petersen, L. A. (2016). 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. American Heart Journal, 181, 74-82.
Available at: https://ecommons.aku.edu/provost_office/84