title: Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners?
abstract: OBJECTIVE
  The aim of this study was to answer the overall question: Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)?
  
  
  BACKGROUND
  In the USA as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary health care is one area where healthcare reform has received considerable attention, in part because of continued projections of primary care physician shortages. Many argue that nurse practitioners are one solution to ease the consequences of the projected shortage of primary care physicians in the USA as well as other developed countries.
  
  
  METHODS
  Cross-sectional quantitative analysis of 2012 Medicare claims data.
  
  
  METHODS
  A 5% Standard Analytic File of 2012 Medicare claims data for beneficiaries with Type 2 diabetes were analysed. A medical productivity index was used to stratify patients as healthiest and least healthy who were seen by either nurse practitioners only or primary care physicians exclusively. Included in the analyses were health services utilization, health outcomes and healthcare cost variables.
  
  
  RESULTS
  The patients in the nurse practitioner only group, overall and stratified by medical productivity index status, had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare services utilization, patient health outcomes and healthcare costs.
  
  
  CONCLUSIONS
  These findings inform current healthcare workforce conversations regarding healthcare quality, outcomes and costs. Our results suggest nurse practitioner engagement in chronic care patient management in primary care settings is associated with lower cost and better quality health care.
authors.affiliation: National Center for Interprofessional Practice and Education, Academic Health Center, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: May Nawal
authors.identifier: http://orcid.org/0000-0001-8856-6970
authors.initials: MN
authors.lastname: Lutfiyya
authors.affiliation: Consultant to the National Center for Interprofessional Practice and Education, Academic Health Center, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Tomai
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Bianca
authors.initials: B
authors.lastname: Frogner
authors.affiliation: National Center for Interprofessional Practice and Education, Academic Health Center, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Cerra
authors.affiliation: School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zismer
authors.affiliation: Carlson School of Management, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Parente
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards*; D009722:Nurse Practitioners / Q000592:standards*; D010820:Physicians / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D014481:United States
keywords: Medicare beneficiaries; healthcare cost comparisons; healthcare reform; nurse practitioners; primary care physicians