The Impact of Using Mid-level Providers in Face-to-Face Primary Care on Health Care Utilization
Bibliographic Data
| ID | 9103827 |
|---|---|
| Authors | Hangsheng Liu (RAND Corporation, Boston, MA, corresponding author), Michael W Robbins (0000-0003-4972-1733, RAND Corporation), Michael Robbins (0000-0001-5012-0623, RAND Corporation, Pittsburgh, PA), Ateev Mehrotra (0000-0003-2223-1582, RAND Corporation, Boston, MA, corresponding author), David Auerbach (0000-0003-1761-8993, Massachusetts Health Policy Commission, Boston, MA), David I Auerbach (0000-0003-2736-0586, Boston Public Health Commission), Brandi E Robinson (Kaiser Permanente), Brandi Robinson (Kaiser Permanente), Lee F Cromwell (Kaiser Permanente), Douglas W Roblin (Kaiser Permanente) |
| Year | 2017 |
| Volume | 55 |
| Issue | 1 |
| Pages | 12-18 |
| Publication date | 2017-01-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000590 |
| PMID | 27367866 |
| OpenAlex | W2460816761 |
| Language | EN |
| Citations received | 1 |
| References cited | 9 |
BACKGROUND: There has been concern that greater use of nurse practitioners (NP) and physician assistants (PA) in face-to-face primary care may increase utilization and spending. OBJECTIVE: To evaluate a natural experiment within Kaiser Permanente in Georgia in the use of NP/PA in primary care. STUDY DESIGN: From 2006 through early 2008 (the preperiod), each NP or PA was paired with a physician to manage a patient panel. In early 2008, NPs and PAs were removed from all face-to-face primary care. Using the 2006-2010 data, we applied a difference-in-differences analytic approach at the clinic level due to patient triage between a NP/PA and a physician. Clinics were classified into 3 different groups based on the percentage of visits by NP/PA during the preperiod: high (over 20% in-person primary care visits attended by NP/PAs), medium (5%-20%), and low (<5%) NP/PA model clinics. MEASURES: Referrals to specialist physicians; emergency department visits and inpatient admissions; and advanced diagnostic imaging services. RESULTS: Compared with the low NP/PA model, the high NP/PA model and the medium NP/PA model were associated with 4.9% and 5.1% fewer specialist referrals, respectively (P<0.05 for both estimates); the high NP/PA model and the medium NP/PA model also showed fewer hospitalizations and emergency department visits and fewer advanced diagnostic imaging services, but none of these was statistically significant. CONCLUSIONS: We find no evidence to support concerns that under a physician's supervision, NPs and PAs increase utilization and spending
Emergency department · Family medicine · Health care · Medical emergency · MEDLINE · Nurse practitioners · Physician assistants · Primary care · Triage · Emergency Medicine · Medicine · Nursing · Nursing education and management · Nursing Roles and Practices · Primary Care and Health Outcomes
| Unique citing works | 1 |
|---|---|
| Citations per year | 0,17 |
| Citation span | 2020 - 2020 (1) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 1 |