Virani Salim S, Akeroyd Julia M, Ramsey David J, Deswal Anita, Nasir Khurram, Rajan Suja S, Ballantyne Christie M, Petersen Laura A
1 Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations; and Section of Health Services Research , Department of Medicine, Baylor College of Medicine, Houston, Texas.
2 Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center , Houston, Texas.
Popul Health Manag. 2018 Jun;21(3):209-216. doi: 10.1089/pop.2017.0090. Epub 2017 Oct 10.
Although effectiveness of diabetes or cardiovascular disease (CVD) care delivery between physicians and advanced practice providers (APPs) has been shown to be comparable, health care resource utilization between these 2 provider types in primary care is unknown. This study compared health care resource utilization between patients with diabetes or CVD receiving care from APPs or physicians. Diabetes (n = 1,022,588) or CVD (n = 1,187,035) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities were identified. Using hierarchical regression adjusting for covariates including patient illness burden, the authors compared number of primary or specialty care visits and number of lipid panels and hemoglobinA1c (HbA1c) tests among diabetes patients, and number of primary or specialty care visits and number of lipid panels and cardiac stress tests among CVD patients receiving care from physicians and APPs. Physicians had significantly larger patient panels compared with APPs. In adjusted analyses, diabetes patients receiving care from APPs received fewer primary and specialty care visits and a greater number of lipid panels and HbA1c tests compared with patients receiving care from physicians. CVD patients receiving care from APPs received more frequent lipid testing and fewer primary and specialty care visits compared with those receiving care from physicians, with no differences in the number of stress tests. Most of these differences, although statistically significant, were numerically small. Health care resource utilization among diabetes or CVD patients receiving care from APPs or physicians appears comparable, although physicians work with larger patient panels.
尽管医生和高级执业提供者（APP）在糖尿病或心血管疾病（CVD）护理提供方面的有效性已被证明具有可比性，但这两种提供者类型在初级保健中的医疗资源利用情况尚不清楚。本研究比较了接受APP或医生治疗的糖尿病或CVD患者之间的医疗资源利用情况。确定了2013年10月至2014年9月期间在130个退伍军人事务设施中进行初级保健就诊的糖尿病患者（n = 1,022,588）或CVD患者（n = 1,187,035）。作者使用分层回归对包括患者疾病负担在内的协变量进行调整，比较了糖尿病患者的初级或专科护理就诊次数、血脂检查次数和糖化血红蛋白（HbA1c）检测次数，以及接受医生和APP治疗的CVD患者的初级或专科护理就诊次数、血脂检查次数和心脏应激试验次数。与APP相比，医生的患者群体明显更大。在调整分析中，与接受医生治疗的患者相比，接受APP治疗的糖尿病患者接受的初级和专科护理就诊次数更少，血脂检查次数和HbA1c检测次数更多。与接受医生治疗的患者相比，接受APP治疗的CVD患者接受血脂检测的频率更高，初级和专科护理就诊次数更少，应激试验次数没有差异。这些差异中的大多数虽然在统计学上具有显著性，但在数值上很小。接受APP或医生治疗的糖尿病或CVD患者的医疗资源利用情况似乎具有可比性，尽管医生治疗的患者群体更大。
