title: Comparing Advanced Practice Providers and Physicians as Providers of e-Visits.
abstract: BACKGROUND
  Although electronic delivery (electronic visits [e-visits]) of healthcare services by advanced practice providers (APPs) is growing, literature defining the roles of different providers and comparing outcomes is lacking. We analyzed two e-visit models at the University of Pittsburgh Medical Center (UPMC) to compare their providers (physicians and APPs) and associated outcomes.
  
  
  METHODS
  We identified all e-visits for the UPMC AnywhereCare Continuity (physician providers for existing patients) and Convenience (physician and APP providers for Pennsylvania residents) services (n=2,184) using Epic Systems (Verona, WI) MyChart data (November 2013-August 2014). We compared e-visits by service and provider type for patient characteristics, volume, response time, primary diagnoses, and number of prescriptions. We used statistical tests to determine differences in patient characteristics and an ordinary least square linear regression, controlling for patient characteristics, to determine differences in prescribing.
  
  
  RESULTS
  Of the completed e-visits (n=1,791), 72.5% were with APPs, and 27.5% were with physicians. APP patients were younger, higher income, and more likely to be unmarried. Sinusitis patients were more likely to use the Continuity service, whereas those with urinary tract or upper respiratory infections were more likely to use the Convenience service. Finally, provider type was significantly associated with prescribing, with APPs prescribing more.
  
  
  CONCLUSIONS
  Some demographic variation exists between users of APP versus physician e-visits. Provider response time seems more driven by service policy than provider type. Finally, variation exists between provider types in quantities of prescriptions written. As health systems and policymakers develop protocols and reimbursement strategies for e-visits, these model considerations will be important.
authors.affiliation: 1 Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Johanna E
authors.initials: JE
authors.lastname: Bellon
authors.affiliation: 2 School of Rehabilitation and Health Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Stevans
authors.affiliation: 3 School of Nursing, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Cohen
authors.affiliation: 1 Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: A Everette
authors.initials: AE
authors.lastname: James
authors.affiliation: 4 Office of Advanced Practice Providers, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Reynolds
authors.affiliation: 1 Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Yuting
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania; D010818:Practice Patterns, Physicians'; D017216:Telemedicine
keywords: business administration/economics; e-health; medical records; pharmacy; telemedicine; telenursing