Physician Assistants And Nurse Practitioners Perform Effective Roles On Teams Caring For Medicare Patients With Diabetes
- Christine Everett ( [email protected] ) is an assistant professor in the Physician Assistant Program, Department of Community and Family Medicine, Duke University School of Medicine, in Durham, North Carolina.
- Carolyn Thorpe is a core investigator at the Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, and an assistant professor of pharmacy and therapeutics at the School of Pharmacy, University of Pittsburgh, in Pennsylvania.
- Mari Palta is a professor of population health sciences at the University of Wisconsin–Madison.
- Pascale Carayon is a professor of industrial and systems engineering at the University of Wisconsin–Madison.
- Christie Bartels is an assistant professor in the Department of Medicine at the University of Wisconsin–Madison.
- Maureen A. Smith is a professor of population health sciences, family medicine, and surgery at the University of Wisconsin–Madison.
Abstract
One approach to the patient-centered medical home, particularly for patients with chronic illnesses, is to include physician assistants (PAs) and nurse practitioners (NPs) on primary care teams. Using Medicare claims and electronic health record data from a large physician group, we compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. Outcomes were generally equivalent in thirteen comparisons. In four comparisons, outcomes were superior for the patients receiving care from PAs or NPs, but in three other comparisons the outcomes were superior for patients receiving care from physicians only. Specific roles performed by PAs and NPs were associated with different patterns in the measure of the quality of diabetes care and use of health care services. No role was best for all outcomes. Our findings suggest that patient characteristics, as well as patients’ and organizations’ goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams. Accordingly, training and policy should continue to support role flexibility for these health professionals.
