title: Quality of diabetes care in family medicine practices: influence of nurse-practitioners and physician's assistants.
abstract: OBJECTIVE
  The aim of this study was to assess whether the quality of diabetes care differs among practices employing nurse-practitioners (NPs), physician's assistants (PAs), or neither, and which practice attributes contribute to any differences in care.
  
  
  METHODS
  This cross-sectional study of 46 family medicine practices from New Jersey and Pennsylvania measured adherence to American Diabetes Association diabetes guidelines via chart audits of 846 patients with diabetes. Practice characteristics were identified by staff surveys. Hierarchical models determined differences between practices with and without NPs or PAs.
  
  
  RESULTS
  Compared with practices employing PAs, practices employing NPs were more likely to measure hemoglobin A(1c) levels (66% vs 33%), lipid levels (80% vs 58%), and urinary microalbumin levels (32% vs 6%); to have treated for high lipid levels (77% vs 56%); and to have patients attain lipid targets (54% vs 37%) (P <or= .005 for each). Practices with NPs were more likely than physician-only practices to assess hemoglobin A(1c) levels (66% vs 49%) and lipid levels (80% vs 68%) (P<or=.007 for each). These effects could not be attributed to use of diabetes registries, health risk assessments, nurses for counseling, or patient reminder systems. Practices with either PAs or NPs were perceived as busier (P=.03) and had larger total staff (P <.001) than physician-only practices.
  
  
  CONCLUSIONS
  Family practices employing NPs performed better than those with physicians only and those employing PAs, especially with regard to diabetes process measures. The reasons for these differences are not clear.
authors.affiliation: Department of Biostatistics, UMDNJ-School of Public Health, Piscataway, New Jersey 08854, USA. ohmanpa@umdnj.edu
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ohman-Strickland
authors.forename: A John
authors.initials: AJ
authors.lastname: Orzano
authors.forename: Shawna V
authors.initials: SV
authors.lastname: Hudson
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: Barbara
authors.initials: B
authors.lastname: DiCiccio-Bloom
authors.forename: Dena
authors.initials: D
authors.lastname: O'Malley
authors.forename: Alfred F
authors.initials: AF
authors.lastname: Tallia
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice / Q000458:organization & administration* / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009515:New Jersey; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends; D010414:Pennsylvania; D010823:Physician Assistants / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000639:trends; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic; D000078329:Workforce