Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care

Abstract

Objective To examine whether nurse practitioner (NP)‐assigned patients exhibited differences in utilization, costs, and clinical outcomes compared to medical doctor (MD)‐assigned patients. Data Sources Veterans Affairs (VA) administrative data capturing characteristics, outcomes, and provider assignments of 806 434 VA patients assigned to an MD primary care provider (PCP) who left VA practice between 2010 and 2012. Study Design We applied a difference‐in‐difference approach comparing outcomes between patients reassigned to MD and NP PCPs, respectively. We examined measures of outpatient (primary care, specialty care, and mental health) and inpatient (total and ambulatory care sensitive hospitalizations) utilization, costs (outpatient, inpatient and total), and clinical outcomes (control of hemoglobin A1c, LDL, and blood pressure) in the year following reassignment. Principal Findings Compared to MD‐assigned patients, NP‐assigned patients were less likely to use primary care and specialty care services and incurred fewer total and ambulatory care sensitive hospitalizations. Differences in costs, clinical outcomes, and receipt of diagnostic tests between groups were not statistically significant. Conclusions Patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients. NPs may offer a cost‐effective approach to addressing anticipated shortages of primary care physicians.

Comparable, but distinct: Perceptions of primary care provided by physicians and nurse practitioners in full and restricted practice authority states

“…Integration of our study's qualitative and quantitative findings (Liu et al., 2020) is forthcoming. Future qualitative studies should focus on female patient preferences and veterans in VHA post Directive 1,350 (Department of Veterans Affairs, 2017).…”

“…Creating sustainable access that does not diminish patient experiences and outcomes may be possible by expanding the number of NPs in primary care practice (Bauer, 2010; Institute of Medicine, 2011). In some cases, this may be more cost‐effective even with complex patients (Liu et al., 2020; Morgan et al., 2019). Moreover, if states allow NPs to operate to the full extent of their licensure, a more fully engaged and productive healthcare workforce may be possible (Bodenheimer & Sinsky, 2014; Sikka, Morath, & Leape, 2015).…”

“…Eligible participants were identified from a quantitative study comparing clinical outcomes between patients receiving care from NPs and physicians respectively (Liu et al., 2020). In a sequential exploratory approach, we used random purposive sampling to separately identify patients and providers (NPs and physicians) to ensure representation from states with full and restricted practice authority (Carthon, Barnes, & Sarik, 2015).…”

“…Since FPA initiation, considerable quantitative evidence has been published on NP care quality, use and costs (Liu et al., 2020; Lockwood, 2019), which supports the use of NPs with FPA in primary care. Qualitative studies of patient or provider perspectives on primary care delivered by NPs are largely outdated given diverse regulatory practices in the US and the shift to FPA (Budzi et al., 2010; Laurant et al., 2008; Leach et al., 2018).…”

State responses to COVID-19: Potential benefits of continuing full practice authority for primary care nurse practitioners

“…Multiple studies since then have evaluated the outcomes of NP care in several health care settings. These included an evaluation of chronic disease management by NPs for nursing home residents ( Bakerjian, 2008 ); the efficiency of NP-provided care in emergency departments ( Carter & Chochinov, 2007 ); pediatric inpatient asthma management ( Borgmeyer, Gyr, Jamerson, & Henry, 2008 ); hospitalization avoidance in patients with diabetes ( Kuo, Chen, Baillargeon, Raji, & Goodwin, 2015 ); hypertension management ( Wright, Romboli, DiTulio, Wogen, & Belletti, 2011 ), and overall primary care management ( Liu et al, 2020 ). The results across the studies were consistent regarding the high quality of care delivered by NPs to diverse groups of patients across multiple settings.…”