Abstract 311: Comparative Effectiveness of Outpatient Cardiovascular Disease Care Delivery Between Physician and Non-Physician Primary Care Providers: Implications for Care Under the Affordable Care Act

Abstract

Introduction: With the Affordable Care Act (ACA) implementation, the current number of physicians will not be sufficient to accommodate 30-40 million Americans receiving health care access. A proposed solution is to utilize non-physicians (nurse practitioners, physician assistants) for chronic disease care. Recent studies have shown comparable quality of outpatient cardiovascular disease (CVD) care between physicians and non physicians in cardiology practices. We compared the quality of CVD care between non-physicians and physicians in a primary care setting. Methods: We identified CVD (ischemic heart disease, cerebrovascular or peripheral artery disease) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities. Using hierarchical regression adjusting for illness-severity and other covariates ( Table ), we compared proportion of patients with BP <140/90 mmHg, LDL-C <100 mg/dL, receiving a statin, receiving moderate to high intensity statin, or receiving a beta-blocker (in those with MI in the last 2 years) among patients receiving care from physicians (n=934,950) and non-physicians(252,085). We also compared the proportion meeting the 3 measures (BP <140/90mmHg, receiving a statin, and receiving a beta-blocker) among eligible patients receiving care from physicians and non-physicians. Results (Table): Although quality of care was numerically comparable; patients receiving care from non-physicians were statistically more likely to have BP control, whereas, patients receiving care from physicians were more likely to have cholesterol control (LDL-C <100 mg/dL, statin or moderate-high intensity statin use), or receive a beta-blocker in adjusted models. Importantly, overall CVD care quality did not differ, with only 54.0% and 54.8% of those receiving care from physicians and non-physicians meeting all 3 eligible measures. Conclusion: Overall CVD care quality delivered by physicians and non-physicians was comparable with modest differences in specific measures. Therefore, a collaborative care delivery model employing physicians and non-physicians may deliver comparable CVD quality to a physician-only model. Regardless of the provider type, there is a need to improve global performance on all eligible measures in CVD patients.