Employment of mid-level providers in primary care and control of diabetes

Published: October 25, 2010
Category: Bibliography > Papers
Authors: Edelman D, Jackson GL, Lee SY, Weinberger M, Yano EM
Countries: United States
Language: null
Types: Population Health
Settings: Hospital

Prim Care Diabetes 5:25-31.

Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC, USA

AIMS: Examine potential associations between inclusion of mid-level providers in United States Veterans Affairs (VA) primary care programs and diabetes control.

METHODS: We established a cohort of diabetes patients (alive October 1, 1999) using the VA Diabetes Registry and VA corporate databases. 1999 VA Survey of Primary Care Practices data were combined with individual-patient information. We used a two-level hierarchical model to determine the relationship between staffing characteristics and hemoglobin A1c (HbA1c), among 88,682 patients from 198 clinics.

RESULTS: Inclusion of nurse practitioners (NPs) at relatively limited levels (% of all providers who are NPs) in the primary care program was significantly associated with HbA1c lower by 0.31 percentage points (95% CI, -0.50% to -0.12%) compared to programs that did not include NPs. Having some level of NP staffing vs. no NP staffing was associated HbA1c lower by 0.25%. Inclusion of physician assistants (PAs) in primary care programs was generally not associated with a statistically significant difference in HbA1c. The exception is that moderate levels of PA staffing were associated with slightly higher HbA1c [0.18%, 95% CI, 0.02-0.34)].

CONCLUSIONS: Diabetes control among primary care patients appeared to benefit from inclusion of NPs, while an analogous association was not found for PAs.

PMID: 20980212

High-Impact Chronic Conditions,Practice Patterns Comparison,Targeted Program,United States,Aged,Biomarkers/blood,Cluster Analysis,Diabetes Mellitus/blood,Diabetes Mellitus/nursing,Gender,Health Care Surveys,Hemoglobin A,Glycosylated/metabolism,Linear Models,Middle Aged,Registries,Time Factors,Treatment Outcome,United States Department of Veterans Affairs

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