A comparison of care provided in practices with nurse practitioners and physicians assistants versus sub-specialist physicians only: A cohort study of XXXX .

@entity1 @entity309
BACKGROUND: The Affordable Care Act proposes wider use of nurse practitioners (NPs) and physician assistants (PAs), but little is known about outcomes of care provided by them in medical specialties. We compared the outcomes of care for @entity1 with @entity309 ( @entity309 ) seen in practices with NPs or PAs and rheumatologists versus practices with rheumatologists only. METHODS: We enrolled seven rheumatology practices in the US - four with NPs or PAs and three without. Disease activity of @entity309 , categorized as remission, low, moderate, or high, using standardized measures were abstracted from medical records from the most recent two years. We performed a repeated measures analysis using generalized linear regression to compare disease activity for visits to practices with NPs or PAs versus rheumatologist only, adjusting for disease duration, serologic status, @entity309 treatments and disease activity measures. RESULTS: Records from 301 @entity1 , including 1982 visits were reviewed. @entity1 had a mean age of 61 years and 77% were female. In the primary adjusted analysis, @entity1 seen in practices with NPs or PAs were less likely to have higher disease activity (OR 0.32, 95% CI 0.17-0.60, p = 0.004) than those seen in practices with rheumatologists only. However, there were no differences in the change in disease activity. CONCLUSIONS: @entity1 seen in practices with NPs or PAs had lower @entity309 disease activity over 2-years compared with those seen in rheumatologist only practices; no differences were observed in the change in disease activity between visits either within or between type of provider practice. This article is protected by copyright. All rights reserved.
