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Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients.

Authors
  • Morgan, Perri A1
  • Smith, Valerie A2
  • Berkowitz, Theodore S Z3
  • Edelman, David4
  • Van Houtven, Courtney H5
  • Woolson, Sandra L6
  • Hendrix, Cristina C7
  • Everett, Christine M8
  • White, Brandolyn S9
  • Jackson, George L10
  • 1 Perri A. Morgan ( [email protected] ) is a professor in the Department of Family Medicine and Community Health, Physician Assistant Program, and Department of Population Health Sciences, Duke University School of Medicine, in Durham, North Carolina.
  • 2 Valerie A. Smith is an assistant professor in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs (VA) Health Care System, and the Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine.
  • 3 Theodore S. Z. Berkowitz is a statistician in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System.
  • 4 David Edelman is a professor in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, and the Division of General Internal Medicine, Duke University School of Medicine.
  • 5 Courtney H. Van Houtven is a research scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, and the Department of Population Health Sciences, Duke University School of Medicine.
  • 6 Sandra L. Woolson is a statistician in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System.
  • 7 Cristina C. Hendrix is an associate professor in the Geriatric Research, Education, and Clinical Center, Durham VA Health Care System and Duke University School of Nursing.
  • 8 Christine M. Everett is an associate professor in the Department of Family Medicine and Community Health, Physician Assistant Program, and Department of Population Health Sciences, Duke University School of Medicine.
  • 9 Brandolyn S. White is a research health science specialist in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System.
  • 10 George L. Jackson is an associate professor in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, and the Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine.
Type
Published Article
Journal
Health affairs (Project Hope)
Publication Date
Jun 01, 2019
Volume
38
Issue
6
Pages
1028–1036
Identifiers
DOI: 10.1377/hlthaff.2019.00014
PMID: 31158006
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex patients with chronic conditions. Research shows good quality outcomes, but concerns persist that NPs' and PAs' care of vulnerable populations could increase care costs compared to the traditional physician-dominated system. We used 2012-13 Veterans Affairs data on a cohort of medically complex patients with diabetes to compare health services use and costs depending on whether the primary care provider was a physician, NP, or PA. Case-mix-adjusted total care costs were 6-7 percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. We found that use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs.

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