Abstract 15347: Provider Type and Quality of Outpatient Cardiovascular Disease Care, Implications for the Affordable Care Act: Insights from the NCDR®PINNACLE Registry
INTRODUCTION: Due to implementation of the Affordable Care Act (ACA), between 30-40 million Americans will be eligible to receive health care coverage. The current number of physicians may not be sufficient to accommodate this patient influx. One proposed solution is to utilize non-physicians (nurse practitioners [NPs] and physician assistants [PAs]) for chronic disease care delivery. It is not known whether the quality of care delivered by non-physicians is comparable to that delivered by physicians.
METHODS: Within the American College of Cardiology’s outpatient PINNACLE® registry, we compared the quality of coronary artery disease (CAD), heart failure (HF), and atrial fibrillation (AF) care delivered by physicians and non-physicians for outpatients with visits between January 1 and December 31, 2012. We performed hierarchical regression with further adjustment for provider gender, number of outpatient visits, and patient’s age, gender, and insurance.
RESULTS: We included 672 providers (540 physicians and 132 non-physicians [114 NPs, 18 PAs]) in 33 practices who cared for 279,770 patients. In adjusted analyses (Table), compliance with most CAD, HF, and AF measures was comparable between physicians and non-physicians, except a lower rate of beta-blocker use, antiplatelet therapy use, and cardiac rehabilitation referral among CAD patients receiving care from physicians compared with non-physicians. Results were consistent when comparing compliance with CAD, HF, and AF measures for practices with physician-only providers (n = 57) versus practices with both physicians and non-physicians (n = 33) (data not shown).
CONCLUSION: A collaborative care delivery model employing both physicians and non-physicians may deliver a comparable quality of outpatient cardiovascular care compared with a physician-only model. These results have implications for how resources are allocated for cardiovascular care delivery as more Americans access care under the ACA.
- Cardiovascular disease
- Healthcare delivery systems
- Quality of medical care
- Nurse practitioners
Author Disclosures: S.S. Virani: None. T.M. Maddox: None. P.S. Chan: None. F. Tang: None. J.M. Akeroyd: None. S. Risch: None. A. Deswal: None. B. Bozkurt: None. C.M. Ballantyne: Research Grant; Significant; Abbott, Amarin, Amgen, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, Pfizer, Regeneron, Roche, Sanofi-Synthelabo, NIH, AHA. Consultant/Advisory Board; Modest; Abbott, Aegerion, Amarin, Amgen, Cerenis, Esperion, Genzyme, Kowa, Novartis, Resverlogix, Regeneron, Roche, Sanofi-Synthelabo. Consultant/Advisory Board; Significant; Merck, Pfizer. L.A. Petersen: None.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.