Does Primary Care Diabetes Management Provided Medicare Patients Differ between Primary Care Physicians and Nurse Practitioners?
Abstract Aims: 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 United States as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary healthcare 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 easing the consequences of the projected shortage of primary care physicians in the United States 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 analyzed. 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 to 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 healthcare.