title: Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician.
abstract: OBJECTIVE
  To examine the process and outcomes of care of COPD patients by Advanced Practice Providers (APPs) and primary care physicians.
  
  
  METHODS
  We conducted a cross sectional retrospective cohort study of Medicare beneficiaries with COPD who had at least one hospitalization in 2010. We examined the process measures of receipt of spirometry evaluation, influenza and pneumococcal vaccine, use of COPD medications, and referral to a pulmonary specialist visit. Outcome measures were emergency department (ER) visit, number of hospitalizations and 30-day readmission in 2010.
  
  
  RESULTS
  A total of 7,257 Medicare beneficiaries with COPD were included. Of these, 1,999 and 5,258 received primary care from APPs and primary care physicians, respectively. Patients in the APP group were more likely to be white, younger, male, residing in non-metropolitan areas and have fewer comorbidities. In terms of process of care measures, APPs were more likely to prescribe short acting bronchodilators (adjusted odds ratio [aOR] = 1.18, 95%Confidence Interval [CI] 1.05-1.32), oxygen therapy (aOR = 1.25, 95% CI 1.12-1.40) and consult a pulmonary specialist (aOR = 1.39, 95% CI 1.23-1.56), but less likely to give influenza and pneumococcal vaccinations. Patients receiving care from APPs had lower rates of ER visits for COPD (aOR = 0.84, 95%CI 0.71-0.98) and had a higher follow-up rate with pulmonary specialist within 30 days of hospitalization for COPD (aOR = 1.25, 95%CI 1.07-1.48) than those cared for by physicians.
  
  
  CONCLUSIONS
  Compared to patients cared for by physicians, patients cared for by APPs were more likely to receive short acting bronchodilator, oxygen therapy and been referred to pulmonologist, however they had lower rates of vaccination probably due to lower age group. Patients cared for by APPs were less like to visit an ER for COPD compared to patients care for by physicians, conversely there was no differences in hospitalization or readmission for COPD between MDs and APPs.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America.
authors.forename: Amitesh
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Office of Biostatistics, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America.|Sealy Center of Aging, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America.
authors.forename: YongFang
authors.initials: Y
authors.lastname: Kuo
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America.|Sealy Center of Aging, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America.
authors.forename: Gulshan
authors.initials: G
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D009722:Nurse Practitioners; D017063:Outcome Assessment, Health Care; D010823:Physician Assistants; D058007:Physicians, Primary Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States