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Less Hospitalizations for Diabetic Patients Under Nurse Practitioners’ Care

Study finds NPs provide comparable quality of clinical care as physicians.

Patients receiving clinical care from nurse practitioners (NPs) have risen over the years. There are several states that allow NPs to practice without physician supervision. This raises a concern as to whether receiving care solely from NPs would be more beneficial than from physicians alone.

Young-Fang Kuo, PhD, and colleagues examined and compared the clinical care that diabetic patients receive solely from either NPs or physicians. The researchers chose to examine diabetes because it is an ambulatory sensitive condition that can lead to hospitalizations, which can be reduced with proper management of the disease state. They hypothesized that “rates of potentially preventable hospitalization would be comparable for patients who received primary care from NPs versus physicians.”

The study included diabetic patients from the national Medicare data who were divided into cohorts that only received care from NPs (93,443 patients) and cohorts that only received care from physicians (252,376 patients). Their primary outcome was the number of hospitalizations for a potentially preventable condition in a given year. They also examined hospitalizations for uncontrolled diabetes.

Results through their multivariable analysis showed that “patients who received care from NPs were less likely to be hospitalized for a potentially preventable condition (OR: 0.90; 95% CI, 0.87-0.93).” In addition, “the association between NP care and hospitalizations for poor diabetes control (eg, hypoglycemia, hyperglycemia, etc.) in the multivariable analysis also showed similar results (OR: 0.94; 95% CI, 0.90-0.98).”

Their findings also showed that “the 4-year mortality rate was 17.15% for patients cared for by NPs and 16.9% for those cared for by physicians (hazard ratio: 1.00 (95% CI, 0.97-1.03).”

Kuo and colleagues proposed that these findings were due to factors that were not able to be controlled in their study. Studies have found that NPs spend more time with their patients, provide them with more information, and have more frequent follow-ups than physicians. In addition to this factor, patients who usually seek care from physicians may have more complex or serious health problems than those who seek care from NPs.

The researchers also found that in nonmetropolitan urban areas and rural areas, there were lower rates of potentially preventable hospitalizations for patients cared for by NPs. However, there was no significant difference between patients cared for by NPs versus physicians in urban areas. This might be due to the shortage of physicians in rural areas and also that physicians who are actually in the rural areas have a larger patient burden, which decreases their ability to spend sufficient time with their patients to properly manage their conditions.

Although Kuo and colleagues hypothesized that care from NPs is comparable with care from physicians, their study showed that clinical care from NPs actually results in less hospitalizations when compared to those receiving care only from physicians. However, due to some of the confounding factors involved, the researchers concluded that their findings support previous research, suggesting that NPs provide comparable quality of clinical care for diabetic patients as physicians.

Practice Pearls:

  • Patients receiving care from NPs has less hospitalizations.
  • NPs spend more time with patients, provide them with more information, and allows for more frequent follow-ups.
  • NPs provide comparable quality of clinical care for diabetic patients as physicians.

Kuo YF, Chen NW, Baillargeon J, Mukaila AR, and Goodwin JS. “Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians.” Medical Care. 2015 Sep;53(9):776-83. Web. 20 Oct 2015.