Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians

Peter Buerhaus, Jennifer Perloff, Sean Clarke, Monica O'Reilly-Jacob, Galina Zolotusky, Catherine M. DesRoches

Research output: Contribution to journalArticle

Abstract

Objective: To examine differences in the quality of care provided by primary care nurse practitioners (PCNPs), primary care physicians (PCMDs), or both clinicians. Data Sources: Medicare part A and part B claims during 2012-2013. Study Design: Retrospective cohort design using standard risk-Adjustment methodologies and propensity score weighting assessing 16 claims-based quality measures grouped into 4 domains of primary care: chronic disease management, preventable hospitalizations, adverse outcomes, and cancer screening. Extraction Methods: Continuously enrolled aged, disabled, and dual eligible beneficiaries who received at least 25% of their primary care services from a random sample of PCMDs, PCNPs, or both clinicians. Principal Findings: Beneficiaries attributed to PCNPs had lower hospital admissions, readmissions, inappropriate emergency department use, and low-value imaging for low back pain. Beneficiaries attributed to PCMDs were more likely than those attributed to PCNPs to receive chronic disease management and cancer screenings. Quality of care for beneficiaries jointly attributed to both clinicians generally scored in the middle of the PCNP and PCMD attributed beneficiaries with the exception of cancer screening. Conclusions: The quality of primary care varies by clinician type, with different strengths for PCNPs and PCMDs. These comparative advantages should be considered when determining how to organize primary care to Medicare beneficiaries.

Original languageEnglish (US)
Pages (from-to)484-490
Number of pages7
JournalMedical care
Volume56
Issue number6
DOIs
StatePublished - Jan 1 2018

Fingerprint

Nurse Practitioners
Quality of Health Care
Medicare
Primary Health Care
Physicians
Early Detection of Cancer
Disease Management
Medicare Part A
Chronic Disease
Risk Adjustment
Patient Readmission
Propensity Score
Information Storage and Retrieval
Primary Care Physicians
Low Back Pain
Hospital Emergency Service
Hospitalization
Retrospective Studies

Keywords

  • Medicare
  • nurse practitioner
  • primary care quality

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians. / Buerhaus, Peter; Perloff, Jennifer; Clarke, Sean; O'Reilly-Jacob, Monica; Zolotusky, Galina; DesRoches, Catherine M.

In: Medical care, Vol. 56, No. 6, 01.01.2018, p. 484-490.

Research output: Contribution to journalArticle

Buerhaus, P, Perloff, J, Clarke, S, O'Reilly-Jacob, M, Zolotusky, G & DesRoches, CM 2018, 'Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians', Medical care, vol. 56, no. 6, pp. 484-490. https://doi.org/10.1097/MLR.0000000000000908
Buerhaus, Peter ; Perloff, Jennifer ; Clarke, Sean ; O'Reilly-Jacob, Monica ; Zolotusky, Galina ; DesRoches, Catherine M. / Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians. In: Medical care. 2018 ; Vol. 56, No. 6. pp. 484-490.
@article{a4e74caec9464a1d875de3cf973d3955,
title = "Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians",
abstract = "Objective: To examine differences in the quality of care provided by primary care nurse practitioners (PCNPs), primary care physicians (PCMDs), or both clinicians. Data Sources: Medicare part A and part B claims during 2012-2013. Study Design: Retrospective cohort design using standard risk-Adjustment methodologies and propensity score weighting assessing 16 claims-based quality measures grouped into 4 domains of primary care: chronic disease management, preventable hospitalizations, adverse outcomes, and cancer screening. Extraction Methods: Continuously enrolled aged, disabled, and dual eligible beneficiaries who received at least 25{\%} of their primary care services from a random sample of PCMDs, PCNPs, or both clinicians. Principal Findings: Beneficiaries attributed to PCNPs had lower hospital admissions, readmissions, inappropriate emergency department use, and low-value imaging for low back pain. Beneficiaries attributed to PCMDs were more likely than those attributed to PCNPs to receive chronic disease management and cancer screenings. Quality of care for beneficiaries jointly attributed to both clinicians generally scored in the middle of the PCNP and PCMD attributed beneficiaries with the exception of cancer screening. Conclusions: The quality of primary care varies by clinician type, with different strengths for PCNPs and PCMDs. These comparative advantages should be considered when determining how to organize primary care to Medicare beneficiaries.",
keywords = "Medicare, nurse practitioner, primary care quality",
author = "Peter Buerhaus and Jennifer Perloff and Sean Clarke and Monica O'Reilly-Jacob and Galina Zolotusky and DesRoches, {Catherine M.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/MLR.0000000000000908",
language = "English (US)",
volume = "56",
pages = "484--490",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians

AU - Buerhaus, Peter

AU - Perloff, Jennifer

AU - Clarke, Sean

AU - O'Reilly-Jacob, Monica

AU - Zolotusky, Galina

AU - DesRoches, Catherine M.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To examine differences in the quality of care provided by primary care nurse practitioners (PCNPs), primary care physicians (PCMDs), or both clinicians. Data Sources: Medicare part A and part B claims during 2012-2013. Study Design: Retrospective cohort design using standard risk-Adjustment methodologies and propensity score weighting assessing 16 claims-based quality measures grouped into 4 domains of primary care: chronic disease management, preventable hospitalizations, adverse outcomes, and cancer screening. Extraction Methods: Continuously enrolled aged, disabled, and dual eligible beneficiaries who received at least 25% of their primary care services from a random sample of PCMDs, PCNPs, or both clinicians. Principal Findings: Beneficiaries attributed to PCNPs had lower hospital admissions, readmissions, inappropriate emergency department use, and low-value imaging for low back pain. Beneficiaries attributed to PCMDs were more likely than those attributed to PCNPs to receive chronic disease management and cancer screenings. Quality of care for beneficiaries jointly attributed to both clinicians generally scored in the middle of the PCNP and PCMD attributed beneficiaries with the exception of cancer screening. Conclusions: The quality of primary care varies by clinician type, with different strengths for PCNPs and PCMDs. These comparative advantages should be considered when determining how to organize primary care to Medicare beneficiaries.

AB - Objective: To examine differences in the quality of care provided by primary care nurse practitioners (PCNPs), primary care physicians (PCMDs), or both clinicians. Data Sources: Medicare part A and part B claims during 2012-2013. Study Design: Retrospective cohort design using standard risk-Adjustment methodologies and propensity score weighting assessing 16 claims-based quality measures grouped into 4 domains of primary care: chronic disease management, preventable hospitalizations, adverse outcomes, and cancer screening. Extraction Methods: Continuously enrolled aged, disabled, and dual eligible beneficiaries who received at least 25% of their primary care services from a random sample of PCMDs, PCNPs, or both clinicians. Principal Findings: Beneficiaries attributed to PCNPs had lower hospital admissions, readmissions, inappropriate emergency department use, and low-value imaging for low back pain. Beneficiaries attributed to PCMDs were more likely than those attributed to PCNPs to receive chronic disease management and cancer screenings. Quality of care for beneficiaries jointly attributed to both clinicians generally scored in the middle of the PCNP and PCMD attributed beneficiaries with the exception of cancer screening. Conclusions: The quality of primary care varies by clinician type, with different strengths for PCNPs and PCMDs. These comparative advantages should be considered when determining how to organize primary care to Medicare beneficiaries.

KW - Medicare

KW - nurse practitioner

KW - primary care quality

UR - http://www.scopus.com/inward/record.url?scp=85047241521&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047241521&partnerID=8YFLogxK

U2 - 10.1097/MLR.0000000000000908

DO - 10.1097/MLR.0000000000000908

M3 - Article

C2 - 29613873

AN - SCOPUS:85047241521

VL - 56

SP - 484

EP - 490

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 6

ER -