Advanced practice clinicians as a usual source of care for adults in the United States.
Advanced practice clinicians (APCs) including nurse practitioners and physician assistants are increasingly used to deliver care, yet little is known about these providers as a usual source of primary care.



This study examined the extent to which APCs serve as a usual source of care and the impact of such use on health care expenditures and quality.



We performed a cross-sectional study by identifying 90,279 adults from the 2002 to 2013 Medical Expenditure Panel Survey who self-reported their usual source of care as either an APC or a primary care physician (PCP). Using complex survey design methods to make national estimates, we compared annual health care expenditures and quality measures among adults whose usual source of care is an APC to that of adults whose usual source of care is a PCP.



Nationally, 32 million adults visit an APC each year, yet only 1.4 million adults report their usual source of care to be an APC. In adjusted analyses, mean annual health care expenditures were $7,323 among APC patients vs. $7,959 among PCP patients, a difference of -$635 (95% confidence interval [-$1,408 to $138]). Across specific health services, APC patients trended toward having lower expenditures except for marginally higher expenditures on emergency room visits ($256 vs. $227 p < .001). APC patients were similar to that of PCP patients across health care quality measures.



Few U.S. adults report their usual source of care to be an APC. Health care spending and quality measures are similar between APC patients and PCP patients. Expanding use of APCs as a usual source of care will likely not lead to increased health care spending.
Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI. Electronic address: mattadav@umich.edu.
Matthew A
MA
Davis
Department of Biostatistics Graduate Program, University of Michigan School of Public Health, Ann Arbor, MI.
Cui
C
Guo
Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI.
Marita G
MG
Titler
Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI.
Christopher R
CR
Friese
D000328:Adult; D057179:Advanced Practice Nursing / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D010823:Physician Assistants / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
Delivery of health care; Health costs; Nurse practitioners; Physician assistants; Primary health care