MedicalResearch.com Interview with:
Salim S. Virani, M.D., Ph.D
Investigator, Health Policy, Quality & Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Staff Cardiologist, Michael E. DeBakey VA Medical Center
Associate Director for Research, Cardiology Fellowship Training Program
Associate Professor (tenured), Section of Cardiovascular Research
Baylor College of Medicine Houston
Medical Research: What is the background for this study? What are the main findings?
Dr. Virani: The increase in Americans securing health care coverage under the Affordable Care Act, in combination with a projected shortage of specialty and non-specialty physicians, has led to a growing pressure on the existing physician workforce in America. One proposed solution is to increase the scope of practice for advanced practice providers (APPs) (nurse practitioners [NPs] and physician assistants [PAs]. An important aspect of this discussion is whether the quality of care provided by APPs is comparable to that provided by physicians.
The study utilized data from the American College of Cardiology’s (ACC) National Cardiovascular Data Registry PINNACLE Registry® to examine whether there were clinically meaningful differences in the quality of coronary artery disease (CAD), heart failure (HF), and atrial fibrillation (AF) care delivered by advanced practice providers versus physicians in a national sample of cardiology practices.
The primary analyses included 883 providers (716 physicians and 167 APPs) in 41 practices who cared for 459,669 patients. The mean number of patients seen by APPs (260.7) was lower compared to that seen by physicians (581.2). Compliance with most CAD, HF, and AF measures was comparable, except for a higher rate of smoking cessation screening and intervention (adjusted rate ratio [RR] 1.14, 95% CI 1.03-1.26) and cardiac rehabilitation referral (RR 1.40, 95% CI 1.16-1.70) among CAD patients receiving care from APPs. Compliance with all eligible CAD measures was low for both (12.1% and 12.2% for APPs and physicians, respectively) with no significant difference. Results were consistent when comparing practices with both physicians and APPs (n = 41) and physician-only practices (n = 49).
Medical Research: What should clinicians and patients take away from your report?
Dr. Virani: The results indicate that apart from minor differences, a collaborative care delivery model employing both physicians and APPs may deliver an overall comparable quality of outpatient cardiovascular care compared to a physician-only model.
Additionally, compliance with global CAD performance measures was low for both provider categories. Given that these performance measures were created to include treatments shown to improve both cardiovascular morbidity and mortality, our results highlight a need for improvement in overall performance on all eligible measures in patients with CAD.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Virani: Future studies should examine differences between physician and APPs when other domains of quality of care (e.g., safety, efficiency, or patient-centeredness), in addition to effectiveness of care, are assessed.
Salim S. Virani, M.D., Ph.D. et al. Provider Type and Quality of Outpatient Cardiovascular Disease Care: Insights From the NCDR PINNACLE Registry. JACC, October 2015 DOI:1016/j.jacc.2015.08.017
Salim S. Virani, M.D., Ph.D (2015). Advance Practice Providers Deliver Quality Cardiac Care