Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians.
OBJECTIVE
To compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners (NPs) with processes and cost of those cared for by primary care physicians (PCPs).


METHODS
Retrospective cohort study.


METHODS
Primary care in communities.


METHODS
Individuals with a diagnosis of diabetes mellitus in 2009 who received all their primary care from NPs or PCPs were selected from a national sample of Medicare beneficiaries (N = 64,354).


METHODS
Propensity score matching within each state was used to compare these two cohorts with regard to rate of eye examinations, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1C) testing, nephropathy monitoring, specialist consultation, and Medicare costs. The two groups were also compared regarding medication adherence and use of statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (for individuals with a diagnosis of hypertension), and potentially inappropriate medications (PIMs).


RESULTS
Nurse practitioners and PCPs had similar rates of LDL-C testing (odds ratio (OR) = 1.01, 95% confidence interval (CI) = 0.94-1.09) and nephropathy monitoring (OR = 1.05, 95% CI = 0.98-1.03), but NPs had lower rates of eye examinations (OR = 0.89, 95% CI = 0.84-0.93) and HbA1C testing (OR = 0.88, 95% CI = 0.79-0.98). NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21-1.37), endocrinologists (OR = 1.64, 95% CI = 1.48-1.82), and nephrologists (OR = 1.90, 95% CI = 1.67-2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01-1.12). There was no statistically significant difference in adjusted Medicare spending between the two groups (P = .56).


CONCLUSIONS
Nurse practitioners were similar to PCPs or slightly lower in their rates of diabetes mellitus guideline-concordant care. NPs used specialist consultations more often but had similar overall costs of care to PCPs.
Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.|Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.|Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.|Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas.
Yong-Fang
YF
Kuo
Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.|Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.|Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.|Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas.
James S
JS
Goodwin
Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
Nai-Wei
NW
Chen
Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.|Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
Kyaw K
KK
Lwin
Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
Jacques
J
Baillargeon
Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.|Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
Mukaila A
MA
Raji
D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000175:diagnosis; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics; D009722:Nurse Practitioners / Q000191:economics; D058007:Physicians, Primary Care / Q000191:economics; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D057216:Propensity Score; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D015351:Vision Screening / Q000706:statistics & numerical data
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Medicare; diabetes mellitus; nurse practitioner; primary care