Adjusted Probabilities of Appropriate Assessment, Treatment, and Target Attainment Among Diabetic Patients by Practice Type
| % (95% CI) | Pairwise Comparison, Rate Ratio (P Value) | ||||||
|---|---|---|---|---|---|---|---|
| Measure | Total No. of Patients | Practices With NPs (n=9) | Practices With PAs (n=9) | Practices With Physicians Only (n=28) | NP vs PA | NP vs Physician-Only | PA vs Physician-Only |
| CI = confidence interval; NP = nurse-practitioner; PA = physician’s assistant; HbA1c = hemoglobin A1c; BP = blood pressure; NA = not applicable. | |||||||
| Note: Probabilities were adjusted for patient-level covariates (age, sex, comorbid conditions, number of visits in last 2 years) and practice-level covariates (solo practice or not, diabetes registry, nurse or health educator for diabetes counseling, reminder system, total staff size). | |||||||
| a Significant after controlling the false-discovery rate at .05 via the Hochberg procedure for multiple testing. | |||||||
| b Credit given if assessed appropriately and within target, or if treated according to guidelines. | |||||||
| c Because rates of treatment were so high, models could not differentiate the effects of NP or PA practice type after accounting for additional patient and practice covariates. | |||||||
| d Includes only patients who were assessed; credit given if at target or treated according to guidelines. | |||||||
| e Credit given if assessed appropriately and within target. | |||||||
| f Includes only patients who were assessed; credit given if at target. | |||||||
| Assessed (all patients) | |||||||
| HbA1c in last 6 months | 846 | 65.5 (57.7–72.5) | 33.4 (17.9–53.4) | 48.9 (36.8–61.2) | 1.96 (.005)a | 1.34 (<.001)a | 0.68 (.21) |
| BP at last 3 visits | 846 | 80.1 (64.1–90.0) | 75.0 (47.5–90.8) | 83.2 (74.3–89.4) | 1.06 (.72) | 0.96 (.63) | 0.90 (.50) |
| Lipids in last 12 months | 846 | 80.1 (72.6–86.0) | 58.2 (45.4–69.9) | 68.3 (55.3–78.9) | 1.37 (.004)a | 1.17 (.007)a | 0.85 (.29) |
| Microalbumin in last12 months | 846 | 31.9 (14.1–57.1) | 6.1 (2.7–13.3) | 18.6 (10.8–30.1) | 5.26 (<.001)a | 1.72 (.10) | 0.33 (.02)a |
| Treated or assessed and at target (all patients)b | |||||||
| HbA1c unadjustedc | 846 | 98.2 | 99.4 | 100.0 | NA | NA | NA |
| BP | 846 | 76.1 (61.4–86.5) | 81.5 (72.7–87.9) | 78.3 (69.5–85.2) | 0.93 (.48) | 0.97 (.72) | 1.04 (.58) |
| Lipids | 846 | 76.6 (66.6–84.4) | 55.9 (43.4–67.8) | 65.7 (60.1–71.0) | 1.37 (.004)a | 1.17 (.03) | 0.85 (.20) |
| Microalbumin | 846 | 79.6 (61.7–90.5) | 61.4 (34.7–82.6) | 65.7 (53.5–76.1) | 1.30 (.26) | 1.21 (.11) | 0.93 (.79) |
| Treated or at target (only if assessed)d | |||||||
| HbA1c unadjustedc | 439 | 100.0 | 100.0 | 100.0 | NA | NA | NA |
| BP | 653 | 78.0 (63.9–87.7) | 81.8 (72.3–88.5) | 79.0 (71.1–85.3) | 0.95 (.63) | 0.99 (.86) | 1.04 (.64) |
| Lipids | 566 | 77.2 (65.3–85.9) | 64.7 (52.2–75.5) | 72.0 (62.8–79.7) | 1.19 (.09) | 1.07 (.32) | 0.90 (.37) |
| Microalbumin | 166 | 98.2 (92.8–99.6) | 86.4 (45.4–98.0) | 97.7 (87.5–99.6) | 1.13 (.07) | 1.01 (.71) | 0.88 (.09) |
| Assessed and at target (all patients)e | |||||||
| HbA1c | 846 | 50.7 (37.3–64.0) | 48.6 (34.6–62.8) | 44.5 (36.5–52.7) | 1.04 (.84) | 1.14 (.36) | 1.09 (.63) |
| BP | 846 | 36.5 (25.0–49.8) | 45.0 (31.5–59.2) | 47.3 (36.9–58.0) | 0.81 (.44) | 0.77 (.13) | 0.95 (.35) |
| Lipids | 846 | 53.5 (45.0–61.8) | 36.8 (30.8–43.1) | 54.4 (49.0–59.8) | 1.45 (.001)a | 0.98 (.85) | 0.68 (<.001)a |
| At target (only if assessed)f | |||||||
| HbA1c | 439 | 52.9 (41.9–63.6) | 54.5 (35.7–72.2) | 59.0 (50.5–67.1) | 0.97 (.89) | 0.90 (.34) | 0.92 (.69) |
| BP | 653 | 37.7 (24.2–53.3) | 45.8 (31.8–60.6) | 46.0 (36.1–56.3) | 0.83 (.51) | 0.82 (.32) | 1.00 (.98) |
| Lipids | 566 | 47.5 (38.6–56.7) | 35.6 (27.5–44.5) | 48.9 (41.4–56.5) | 1.33 (.047) | 0.97 (.78) | 0.73 (.04) |